Provider Demographics
NPI:1275691107
Name:JOHN J TZENG MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN J TZENG MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TZENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-281-0501
Mailing Address - Street 1:736 S GARFIELD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4437
Mailing Address - Country:US
Mailing Address - Phone:626-281-0501
Mailing Address - Fax:626-281-2945
Practice Address - Street 1:736 S GARFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4437
Practice Address - Country:US
Practice Address - Phone:626-281-0501
Practice Address - Fax:626-281-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53439174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534390Medicaid
CAA53439Medicare ID - Type UnspecifiedMEDICARE#
CA00A534390Medicaid