Provider Demographics
NPI:1104922384
Name:LAI, TIMOTHY TUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TUAN
Last Name:LAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 ALMADEN EXPRESSWAY
Mailing Address - Street 2:SUITE #160
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120
Mailing Address - Country:US
Mailing Address - Phone:408-927-7378
Mailing Address - Fax:408-927-9161
Practice Address - Street 1:5945 ALMADEN EXPRESSWAY
Practice Address - Street 2:SUITE #160
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120
Practice Address - Country:US
Practice Address - Phone:408-927-7378
Practice Address - Fax:408-927-9161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice