Basic Information
| Provider Information | |||||||||
| NPI: | 1790193894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAI | ||||||||
| FirstName: | STEVE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11480 BROOKSHIRE AVE. | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628691201 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Practice Location | |||||||||
| Address1: | 11480 BROOKSHIRE AVE. | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628691201 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2014 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 51785 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 51785 | 01 | CA | PHYSICIAN ASSISTANT LICENSE | OTHER |