Provider Demographics
NPI:1639326465
Name:TSE, WAI KIT
Entity Type:Individual
Prefix:MR
First Name:WAI KIT
Middle Name:
Last Name:TSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6721
Mailing Address - Country:US
Mailing Address - Phone:718-478-1135
Mailing Address - Fax:718-478-5056
Practice Address - Street 1:8005 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6721
Practice Address - Country:US
Practice Address - Phone:718-478-1135
Practice Address - Fax:718-478-5056
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02720987Medicaid