Provider Demographics
NPI:1255957882
Name:TSANG, EDWIN (DMD, MSD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:TSANG
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 ROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1346
Mailing Address - Country:US
Mailing Address - Phone:808-382-3883
Mailing Address - Fax:
Practice Address - Street 1:999 E STANLEY BLVD STE C
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4050
Practice Address - Country:US
Practice Address - Phone:925-258-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361921223G0001X
CADDS1068791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty