Healthcare Provider Details

I. General information

NPI: 1114161205
Provider Name (Legal Business Name): ELLICK TSANG M D CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE SUITE 304
DALY CITY CA
94015-2228
US

IV. Provider business mailing address

3055 26TH AVE
SAN FRANCISCO CA
94132-1545
US

V. Phone/Fax

Practice location:
  • Phone: 650-992-8484
  • Fax: 650-992-8480
Mailing address:
  • Phone: 650-992-8484
  • Fax: 650-992-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA053928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA053928
License Number StateCA

VIII. Authorized Official

Name: DR. ELLICK TSANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-992-8484