Healthcare Provider Details

I. General information

NPI: 1457431348
Provider Name (Legal Business Name): FRANKLIN MUNG TSE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 N PERRIS BLVD
PERRIS CA
92571-4726
US

IV. Provider business mailing address

1675 N PERRIS BLVD
PERRIS CA
92571-4726
US

V. Phone/Fax

Practice location:
  • Phone: 951-956-2400
  • Fax: 951-956-2345
Mailing address:
  • Phone: 951-956-2400
  • Fax: 951-956-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: