Provider Demographics
NPI:1598708653
Name:MO, STEVEN TSUNGYU (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:TSUNGYU
Last Name:MO
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 1:848 OESTE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1855
Mailing Address - Country:US
Mailing Address - Phone:916-927-1114
Mailing Address - Fax:916-927-3244
Practice Address - Street 1:1 SCRIPPS DR #202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-927-1114
Practice Address - Fax:916-927-3244
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G51350Medicare UPIN