Provider Demographics
NPI:1053301200
Name:TSAI, EUGENE WAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:WAYNE
Last Name:TSAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 SOUTH ST
Mailing Address - Street 2:#102
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-7053
Mailing Address - Country:US
Mailing Address - Phone:562-865-2402
Mailing Address - Fax:562-865-6621
Practice Address - Street 1:12225 SOUTH ST
Practice Address - Street 2:#102
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7053
Practice Address - Country:US
Practice Address - Phone:562-865-2402
Practice Address - Fax:562-865-6621
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70444207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA70444AMedicare PIN
I02896Medicare UPIN
CAA70444Medicare ID - Type Unspecified