Provider Demographics
NPI:1972822989
Name:HAM, TIFFANY HSU (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:HSU
Last Name:HAM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:HUEY
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:355 LENNON LN
Mailing Address - Street 2:#215
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2475
Mailing Address - Country:US
Mailing Address - Phone:925-482-6223
Mailing Address - Fax:925-357-3777
Practice Address - Street 1:355 LENNON LN
Practice Address - Street 2:#215
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2475
Practice Address - Country:US
Practice Address - Phone:925-482-6223
Practice Address - Fax:925-357-3777
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry