Provider Demographics
NPI:1124387014
Name:JEFFREY TSENG, MD, INC.
Entity Type:Organization
Organization Name:JEFFREY TSENG, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-338-2616
Mailing Address - Street 1:2220 LYNN RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1904
Mailing Address - Country:US
Mailing Address - Phone:805-496-8103
Mailing Address - Fax:805-496-9661
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-496-8103
Practice Address - Fax:805-496-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101924261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ469AOtherMEDICARE NUMBER