Provider Demographics
NPI:1073795027
Name:TSAI, IRENE STYADI (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:STYADI
Last Name:TSAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 CARNEGIE DR
Mailing Address - Street 2:STE. #230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3502
Mailing Address - Country:US
Mailing Address - Phone:909-890-0407
Mailing Address - Fax:
Practice Address - Street 1:685 CARNEGIE DR
Practice Address - Street 2:STE. #230
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3502
Practice Address - Country:US
Practice Address - Phone:909-890-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics