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General NPI Number Information
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NPI Number | 1902543614
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Entity Type | Organization
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Legal Business Name | GRACE TSAI DPM PODIATRY INC
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Dates
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Enumeration Date | 05/14/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 3711 INGLEWOOD BLVD APT 10
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City | LOS ANGELES
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State | CA
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Zip | 90066-3260
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Country | US
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Telephone | 646-533-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 3711 INGLEWOOD BLVD APT 10
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City | LOS ANGELES
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State | CA
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Zip | 90066-3260
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Country | US
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Telephone | 646-533-9070
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GRACE LEE TSAI
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Credential | DPM
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Telephone | 646-533-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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