Provider Demographics
NPI:1356325104
Name:TSE, GLENN SAU-SHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:SAU-SHUN
Last Name:TSE
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:SURGERY CLINIC
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-4147
Mailing Address - Fax:916-784-5405
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:SURGERY CLINIC
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-4147
Practice Address - Fax:916-784-5405
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A7546002086S0102X, 2086S0127X
CAA75460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A754600Medicaid
CA00A754600Medicaid