Provider Demographics
NPI:1023143344
Name:EMERALD SEINMAYA TAY M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EMERALD SEINMAYA TAY M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-307-8636
Mailing Address - Street 1:222 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3596
Mailing Address - Country:US
Mailing Address - Phone:626-307-8636
Mailing Address - Fax:626-307-8705
Practice Address - Street 1:222 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3596
Practice Address - Country:US
Practice Address - Phone:626-307-8636
Practice Address - Fax:626-307-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72223261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A722230Medicaid
CAW16412Medicare PIN
CA00A722230Medicaid