Healthcare Provider Details

I. General information

NPI: 1255730685
Provider Name (Legal Business Name): CONRAD TSENG MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD #107
BEVERLY HILLS CA
90211-2222
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD #107
BEVERLY HILLS CA
90211-2222
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3000
  • Fax: 310-659-8797
Mailing address:
  • Phone: 310-652-3000
  • Fax: 310-659-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA74027
License Number StateCA

VIII. Authorized Official

Name: CONRAD TSENG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-652-3000