Provider Demographics
NPI:1497747232
Name:TSAO, JUNA (MD)
Entity Type:Individual
Prefix:
First Name:JUNA
Middle Name:
Last Name:TSAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-0118
Mailing Address - Country:US
Mailing Address - Phone:909-382-7180
Mailing Address - Fax:909-382-7136
Practice Address - Street 1:1454 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-0118
Practice Address - Country:US
Practice Address - Phone:909-382-7180
Practice Address - Fax:909-382-7136
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH18931OtherUPIN
CA00A631930Medicare PIN