Healthcare Provider Details

I. General information

NPI: 1629074349
Provider Name (Legal Business Name): JUNG T TSAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S ELM ST
WALLINGFORD CT
06492-4741
US

IV. Provider business mailing address

15 S ELM ST
WALLINGFORD CT
06492-4741
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-4562
  • Fax: 203-265-5835
Mailing address:
  • Phone: 203-265-4562
  • Fax: 203-265-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number020739
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: