Provider Demographics
NPI:1710938394
Name:TSUKADA, GLENN H (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:H
Last Name:TSUKADA
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 1:150 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2005
Practice Address - Country:US
Practice Address - Phone:619-295-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA602352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602350Medicaid
CAWA60235EMedicare PIN
CAWA60235BMedicare PIN
CA00A602351Medicare PIN
G91470Medicare UPIN
CA00A602350Medicaid
CA00A602352Medicare PIN
CAWA60235AMedicare PIN
CA300119644Medicare PIN
CAWA60235CMedicare PIN