Provider Demographics
NPI:1578992368
Name:COLLIN TSAI
Entity Type:Organization
Organization Name:COLLIN TSAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPETICS
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-724-3800
Mailing Address - Street 1:415 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3667
Mailing Address - Country:US
Mailing Address - Phone:323-724-3800
Mailing Address - Fax:323-722-4892
Practice Address - Street 1:415 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3667
Practice Address - Country:US
Practice Address - Phone:323-724-3800
Practice Address - Fax:323-722-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58983261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental