Healthcare Provider Details

I. General information

NPI: 1396141537
Provider Name (Legal Business Name): SHUN-JU TSAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 VENICE BLVD
LOS ANGELES CA
90034-3216
US

IV. Provider business mailing address

4061 W 138TH ST APT 29
HAWTHORNE CA
90250-1104
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax:
Mailing address:
  • Phone: 213-814-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: