Healthcare Provider Details

I. General information

NPI: 1013909407
Provider Name (Legal Business Name): ISAAC K TSAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

341 MAGNOLIA AVE. SUITE 205
CORONA CA
92879-3120
US

IV. Provider business mailing address

341 MAGNOLIA AVE SUITE 205
CORONA CA
92879-3330
US

V. Phone/Fax

Practice location:
  • Phone: 951-735-4771
  • Fax: 951-735-3855
Mailing address:
  • Phone: 951-735-4771
  • Fax: 951-735-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA39031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: