Provider Demographics
NPI:1275581001
Name:TSANG, LINDA ETHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ETHEL
Last Name:TSANG
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 1:415 W CARROLL AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4208
Mailing Address - Country:US
Mailing Address - Phone:626-914-5219
Mailing Address - Fax:626-914-7846
Practice Address - Street 1:415 W CARROLL AVE
Practice Address - Street 2:STE 204
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-914-5219
Practice Address - Fax:626-914-7846
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A616960Medicaid
CA441866Medicare UPIN
CA00A616960Medicaid