Provider Demographics
NPI:1508957739
Name:AN KON TSAI M.D.S.C.
Entity Type:Organization
Organization Name:AN KON TSAI M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AN KON
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-1355
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60454-0314
Mailing Address - Country:US
Mailing Address - Phone:708-636-1355
Mailing Address - Fax:708-636-1485
Practice Address - Street 1:10448 S PULASKI RD
Practice Address - Street 2:SUITE 3
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4895
Practice Address - Country:US
Practice Address - Phone:708-636-1355
Practice Address - Fax:708-636-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10659955286OtherHUMANA
ILDE4529OtherMEDICARE RAILROAD CARRIER
0585849OtherAETNA HEALTH OF IL INC
IL0021605077OtherBLUE CROSS BLUE SHIELD
10659955286OtherHUMANA