Healthcare Provider Details

I. General information

NPI: 1417271743
Provider Name (Legal Business Name): CHIH-HUI TSAI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 SAN BERNARDINO ST STE 209
MONTCLAIR CA
91763-2328
US

IV. Provider business mailing address

4950 SAN BERNARDINO ST STE 209
MONTCLAIR CA
91763-2328
US

V. Phone/Fax

Practice location:
  • Phone: 909-500-4060
  • Fax: 909-738-0688
Mailing address:
  • Phone: 909-500-4060
  • Fax: 909-738-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4872
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE4872
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: