Healthcare Provider Details

I. General information

NPI: 1366897456
Provider Name (Legal Business Name): STACY TSAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD STE 280W
SANTA MONICA CA
90404-2172
US

IV. Provider business mailing address

4140 W 190TH ST FL 2
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-7678
  • Fax:
Mailing address:
  • Phone: 310-829-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number71108
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number71108
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberA153266
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71108
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: