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General NPI Number Information
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NPI Number | 1114161205
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Entity Type | Organization
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Legal Business Name | ELLICK TSANG M D CORPORATION
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 04/21/2009
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Provider Practice Location Address
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Address Line | 1800 SULLIVAN AVE SUITE 304
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City | DALY CITY
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State | CA
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Zip | 94015-2228
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Country | US
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Telephone | 650-992-8484
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Fax | 650-992-8480
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Provider Business Mailing Address
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Address Line | 3055 26TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1545
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Country | US
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Telephone | 650-992-8484
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Fax | 650-992-8480
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLICK TSANG
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Credential | M.D.
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Telephone | 650-992-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A053928
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A053928
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License Number State | CA
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