Provider Demographics
NPI:1568494763
Name:TSANG, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:TSANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1530 BESSIE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3080
Mailing Address - Country:US
Mailing Address - Phone:209-833-6221
Mailing Address - Fax:209-839-0814
Practice Address - Street 1:1530 BESSIE AVE
Practice Address - Street 2:#103
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3080
Practice Address - Country:US
Practice Address - Phone:209-833-6221
Practice Address - Fax:209-839-0814
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA697920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697920Medicaid
G66004Medicare UPIN
CA00A697920Medicaid