Provider Demographics
NPI:1891778015
Name:TAN, ELIZABETH YAP (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:YAP
Last Name:TAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 NEWPARK MALL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560
Mailing Address - Country:US
Mailing Address - Phone:510-791-8118
Mailing Address - Fax:510-797-8881
Practice Address - Street 1:5270 NEWPARK MALL RD.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560
Practice Address - Country:US
Practice Address - Phone:510-791-8118
Practice Address - Fax:510-797-8881
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist