Healthcare Provider Details

I. General information

NPI: 1265759807
Provider Name (Legal Business Name): JILL TSENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DRIVE SOUTH PAV III, BLDG 29, SUITE 501
ORANGE CA
92868-5900
US

IV. Provider business mailing address

333 CITY BLVD W STE 1400
ORANGE CA
92868-5900
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8000
  • Fax: 714-456-8055
Mailing address:
  • Phone: 714-456-8020
  • Fax: 714-456-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA156171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: