Provider Demographics
NPI:1316014053
Name:TSAO, JOHN J (LIC AC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:TSAO
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-0798
Mailing Address - Country:US
Mailing Address - Phone:207-846-4433
Mailing Address - Fax:
Practice Address - Street 1:6 BENNETT RD
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6757
Practice Address - Country:US
Practice Address - Phone:207-846-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist