MEDICARE: BAYSHORE REHABILITATION MEDICINE, INC.

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	208100000X	Physical Medicine & Rehabilitation Physician	20A8796	CA

General Provider Information

NPI Number	:	1285834564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE REHABILITATION MEDICINE, INC.

Provider Business Mailing Address
First Line	:	3356 KALLIN AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 SUPERIOR AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3628
Country	:	US
Telephone Number	:	562-679-1068
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALICE TSAI
Credential	:	D.O.
Telephone Number	:	562-679-1068

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/25/2008

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