Provider Demographics
NPI:1609897271
Name:TSENG, EDWIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:T
Last Name:TSENG
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 1:2220 LYNN RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1904
Mailing Address - Country:US
Mailing Address - Phone:805-469-8103
Mailing Address - Fax:805-496-9661
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-469-8103
Practice Address - Fax:805-496-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27697Medicare UPIN
CAA35161Medicare ID - Type Unspecified