Healthcare Provider Details

I. General information

NPI: 1851554364
Provider Name (Legal Business Name): ELIZABETH TIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E 120TH ST
LOS ANGELES CA
90059-3052
US

IV. Provider business mailing address

1720 E 120TH ST
LOS ANGELES CA
90059-3052
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-4272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number256438
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number170465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: