Basic Information
| Provider Information | |||||||||
| NPI: | 1053371559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TSENG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | RA NIEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1498 SOUTHGATE AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507554492 | ||||||||
| FaxNumber: | 6507554466 | ||||||||
| Practice Location | |||||||||
| Address1: | 1498 SOUTHGATE AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507554492 | ||||||||
| FaxNumber: | 6507554466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 12/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A66496 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A664960 | 05 | CA | MEDICAID | 00A664961 | 01 | CA | BLUE SHIELD | OTHER |