Provider Demographics
NPI:1073624276
Name:TSENG, MICKEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICKEY
Middle Name:M
Last Name:TSENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2228 LILIHA ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1651
Mailing Address - Country:US
Mailing Address - Phone:808-484-1169
Mailing Address - Fax:808-484-1168
Practice Address - Street 1:2228 LILIHA ST
Practice Address - Street 2:SUITE #101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1650
Practice Address - Country:US
Practice Address - Phone:808-531-5070
Practice Address - Fax:808-531-5074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-10396207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08770201Medicaid
G79837Medicare UPIN
HI08770201Medicaid