Provider Demographics
NPI:1740808435
Name:TAY, LESLIE WAN-YI (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:WAN-YI
Last Name:TAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 COAL MINE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1921
Mailing Address - Country:US
Mailing Address - Phone:916-712-4228
Mailing Address - Fax:
Practice Address - Street 1:3410 GRAND AVE STE F
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1473
Practice Address - Country:US
Practice Address - Phone:909-364-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1059121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry