Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 32245 | TX |
NPI | 1053868331 |
---|---|
Provider Name | Chia-Yin Tai |
First Address | Irving, TX 75039-3142 |
Second Address | Richardson, TX 75080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2016 |
Last Update Date | 19/07/2018 |