Healthcare Provider Details

I. General information

NPI: 1619177789
Provider Name (Legal Business Name): LAWRENCE TSAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 110
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 110
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8000
  • Fax: 253-382-8019
Mailing address:
  • Phone: 253-382-8000
  • Fax: 253-382-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR7985
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7985
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60097718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: