Healthcare Provider Details

I. General information

NPI: 1376527366
Provider Name (Legal Business Name): JOHN T TSAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR SUITE 101
FAIRFAX VA
22033-1710
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR SUITE 101
FAIRFAX VA
22033-1710
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-0900
  • Fax: 703-391-2919
Mailing address:
  • Phone: 703-391-0900
  • Fax: 703-391-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101238865
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: