Provider Demographics
NPI:1477856680
Name:HENRY TSENG DPM A PODIATRIC MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HENRY TSENG DPM A PODIATRIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:TSENG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-330-4866
Mailing Address - Street 1:2707 E VALLEY BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3198
Mailing Address - Country:US
Mailing Address - Phone:626-330-4866
Mailing Address - Fax:
Practice Address - Street 1:2707 E VALLEY BLVD STE 303
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3198
Practice Address - Country:US
Practice Address - Phone:626-330-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEG583A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3860250001Medicare NSC
CAEG583AMedicare PIN