=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497910129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR THOMAS TSENG MEDICAL CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2008
-----------------------------------------------------
Last Update Date | 08/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 880 S ATLANTIC BLVD STE 208
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-289-9478
-----------------------------------------------------
Fax | 626-289-9718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 880 S ATLANTIC BLVD STE 208
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-289-9478
-----------------------------------------------------
Fax | 626-289-9718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS MU-REN TSENG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 626-289-9478
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 20A6968
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------