MEDICARE: DEREK TSAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		CA

General Provider Information

NPI Number	:	1043824931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK TSAO

Provider Business Mailing Address
First Line	:	1860 N TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-4605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 N TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-4605
Country	:	US
Telephone Number	:	714-998-8403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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Directions to “ DEREK TSAO ” Practice Location

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