Healthcare Provider Details

I. General information

NPI: 1952532475
Provider Name (Legal Business Name): PO-HENG TSAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E WILLETTA ST
PHOENIX AZ
85006
US

IV. Provider business mailing address

901 E WILLETTA ST
PHOENIX AZ
85006-2727
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberME110560
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA93563
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number56576
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: