Provider Demographics
NPI:1568425148
Name:LI, TSUNG TSUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TSUNG
Middle Name:TSUAN
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 DWIGHT WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2212
Mailing Address - Country:US
Mailing Address - Phone:510-845-4500
Mailing Address - Fax:510-845-0360
Practice Address - Street 1:2316 DWIGHT WAY STE 1
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2212
Practice Address - Country:US
Practice Address - Phone:510-845-4500
Practice Address - Fax:510-845-0360
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74650207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G746500Medicaid
CAG74650OtherALTA BATES MEDICAL GROUP
CA012531OtherHILLS PHYSICIANS
CA00G746500Medicaid
CA040010971Medicare PIN