MEDICARE: AMANDA KIT-LING TSE MD

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	207Q00000X	Family Medicine Physician	S8780	TX

General Provider Information

NPI Number	:	1083110639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KIT-LING TSE MD

Provider Business Mailing Address
First Line	:	3417 GASTON AVE
Second Line	:	STE 1000
City	:	DALLAS
State	:	TX
Zip	:	75246-2037
Country	:	US
Telephone Number	:	318-626-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 GASTON AVE STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2037
Country	:	US
Telephone Number	:	469-800-9000
Fax Number	:	469-800-9010

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	03/14/2023

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