MEDICARE: LAURA TSU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	36766	TX
2	122300000X	Dentist	101858	CA

General Provider Information

NPI Number	:	1659897056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA TSU

Provider Business Mailing Address
First Line	:	1324 S DONNA BETH AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-3923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SPRINGTOWN WAY STE 108
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-3856
Country	:	US
Telephone Number	:	512-717-6053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	02/21/2022

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Directions to “ LAURA TSU ” Practice Location

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