Healthcare Provider Details

I. General information

NPI: 1902001597
Provider Name (Legal Business Name): HUGH VAN TSAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N MISSION RD
LOS ANGELES CA
90033-1019
US

IV. Provider business mailing address

1810 N LARK ELLEN AVE
WEST COVINA CA
91791-3843
US

V. Phone/Fax

Practice location:
  • Phone: 323-336-3691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: