Provider Demographics
NPI:1316111321
Name:TSE, KWOK WAI (DMD)
Entity type:Individual
Prefix:
First Name:KWOK WAI
Middle Name:
Last Name:TSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 HUNTINGTON AVE
Mailing Address - Street 2:#216
Mailing Address - City:SO SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080
Mailing Address - Country:US
Mailing Address - Phone:650-873-3384
Mailing Address - Fax:650-873-5946
Practice Address - Street 1:1475 HUNTINGTON AVE
Practice Address - Street 2:#216
Practice Address - City:SO SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080
Practice Address - Country:US
Practice Address - Phone:650-873-3384
Practice Address - Fax:650-873-5946
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice