Provider Demographics
NPI:1184395493
Name:KOHAN AND TSAI PROFESSIONAL DENTAL CORPORATION OF FONTANA
Entity type:Organization
Organization Name:KOHAN AND TSAI PROFESSIONAL DENTAL CORPORATION OF FONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-794-4279
Mailing Address - Street 1:9190 SIERRA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8613
Mailing Address - Country:US
Mailing Address - Phone:909-356-4200
Mailing Address - Fax:
Practice Address - Street 1:9190 SIERRA AVE STE 101
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8613
Practice Address - Country:US
Practice Address - Phone:909-356-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty