Provider Demographics
NPI:1427023068
Name:TSAI, IVAN YOUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:YOUNG
Last Name:TSAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1705
Mailing Address - Country:US
Mailing Address - Phone:714-840-2020
Mailing Address - Fax:714-840-2025
Practice Address - Street 1:5890 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1705
Practice Address - Country:US
Practice Address - Phone:714-840-2020
Practice Address - Fax:714-840-2025
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11335T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY16365OtherMEDICARE GROUP UPIN
CASD11335T0OtherBLUE SHIELD PROVIDER PIN
CAW17925OtherMEDICARE GROUP PIN
CAY16365OtherMEDICARE GROUP UPIN
CAU83462Medicare UPIN