MEDICARE: EDWIN TSAI M.S., BCBA

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	103K00000X	Behavior Analyst	1-16-21742	CA

General Provider Information

NPI Number	:	1255793626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN TSAI M.S., BCBA

Provider Business Mailing Address
First Line	:	9135 JUDICIAL DR APT 3209
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4664
Country	:	US
Telephone Number	:	626-617-9431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 TRUXTUN RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-6154
Country	:	US
Telephone Number	:	626-617-9431
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	08/03/2022

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