Provider Demographics
NPI:1962440263
Name:TAY, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:TAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:39270 PASEO PADRE PKWY
Mailing Address - Street 2:SUITE 518
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1616
Mailing Address - Country:US
Mailing Address - Phone:510-795-8186
Mailing Address - Fax:510-792-8186
Practice Address - Street 1:39233 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-795-8186
Practice Address - Fax:510-792-8186
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G631400Medicaid
CA00G631400Medicaid
CA00G631400Medicare PIN
CAE66681Medicare UPIN
CABF211ZMedicare PIN