Healthcare Provider Details

I. General information

NPI: 1346276540
Provider Name (Legal Business Name): JUSTINA JENNAN TSENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 MARKET ST
SAN DIEGO CA
92102-4715
US

IV. Provider business mailing address

1809 NATIONAL AVE
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2560
  • Fax:
Mailing address:
  • Phone: 619-906-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC54040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: