Healthcare Provider Details

I. General information

NPI: 1790193894
Provider Name (Legal Business Name): STEVE TAI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE. SUITE 309
DOWNEY CA
90241-5025
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE. SUITE 309
DOWNEY CA
90241-5025
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-1201
  • Fax: 562-869-1281
Mailing address:
  • Phone: 562-869-1201
  • Fax: 562-869-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: