Provider Demographics
NPI:1104338805
Name:TAI, SYDNEY LOUISE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LOUISE
Last Name:TAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYD
Other - Middle Name:LOU
Other - Last Name:WAHLSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:408-287-6200
Mailing Address - Fax:408-998-1535
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-287-6200
Practice Address - Fax:408-271-3909
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1128631041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical