Provider Demographics
NPI:1093017121
Name:KE-PING TSAO, MD
Entity Type:Organization
Organization Name:KE-PING TSAO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KE-PING
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-543-9377
Mailing Address - Street 1:1035 PEACH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2700
Mailing Address - Country:US
Mailing Address - Phone:805-543-9377
Mailing Address - Fax:805-543-1820
Practice Address - Street 1:1035 PEACH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2700
Practice Address - Country:US
Practice Address - Phone:805-543-9377
Practice Address - Fax:805-543-1820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KE-PING TSAO, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A260710Medicaid
CA1902979636OtherINDIVIDUAL NPI
CA00A260710Medicaid