Provider Demographics
NPI:1104388875
Name:TSENG, TINA YAH
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:YAH
Last Name:TSENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 TULLY RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:408-271-3900
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC17189104100000X, 101YA0400X, 1041C0700X, 101YP2500X
CACI37161222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical