Provider Demographics
NPI:1801936471
Name:TYAN, DOLLY B (PHD)
Entity type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:B
Last Name:TYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3373 HILLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1204
Mailing Address - Country:US
Mailing Address - Phone:650-736-8917
Mailing Address - Fax:650-725-4470
Practice Address - Street 1:3373 HILLVIEW AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1204
Practice Address - Country:US
Practice Address - Phone:650-736-8917
Practice Address - Fax:650-725-4470
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRK20174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist