Basic Information
| Provider Information | |||||||||
| NPI: | 1851623672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TSAI | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | I-CHING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25733 BARTON RD | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097982755 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25733 BARTON RD | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097982755 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 56874 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.