Provider Demographics
NPI:1063623536
Name:TAN, IRENE CHING-PING (DDS)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:CHING-PING
Last Name:TAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FREMONT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5698
Mailing Address - Country:US
Mailing Address - Phone:650-559-9801
Mailing Address - Fax:650-559-9803
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5698
Practice Address - Country:US
Practice Address - Phone:650-559-9801
Practice Address - Fax:650-559-9803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist