Provider Demographics
NPI:1407018609
Name:TIN, SAN AYE (DDS)
Entity type:Individual
Prefix:
First Name:SAN AYE
Middle Name:
Last Name:TIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAN AYE
Other - Middle Name:
Other - Last Name:TIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2400 FENTON ST
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3596
Mailing Address - Country:US
Mailing Address - Phone:619-656-3100
Mailing Address - Fax:619-216-9006
Practice Address - Street 1:2400 FENTON ST
Practice Address - Street 2:SUITE A-100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3596
Practice Address - Country:US
Practice Address - Phone:619-656-3100
Practice Address - Fax:619-216-9006
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice