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NPI Code Detail

MEDICARE: MADELINE TIEN

MEDICARE: MADELINE TIEN
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1568041424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE TIEN
Provider Business Mailing Address
First Line : 1019 S CENTRAL AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91204-2210
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1019 S CENTRAL AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91204-2210
Country : US
Telephone Number : 818-244-4374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2021
Last Update Date : 01/23/2022

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Directions to “ MADELINE TIEN ” Practice Location

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