Basic Information
| Provider Information | |||||||||
| NPI: | 1851462055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TSAI | ||||||||
| FirstName: | TSUONG | ||||||||
| MiddleName: | WU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3581 PALMER DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CAMERON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956828236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306766600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3581 PALMER DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CAMERON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956828236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306766600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207RH0003X | A51644 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | F67365 | 05 | CA | MEDICAID |