Provider Demographics
NPI:1871861559
Name:CLARK S TSAI, M.D., INC.
Entity Type:Organization
Organization Name:CLARK S TSAI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-864-8886
Mailing Address - Street 1:2225 PORT CHICAGO HWY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2051
Mailing Address - Country:US
Mailing Address - Phone:925-864-8886
Mailing Address - Fax:925-689-7748
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 444
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:925-864-8886
Practice Address - Fax:925-689-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76192207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G761992Medicaid
CAY27763Medicare UPIN
CA00G761992Medicaid
CAZZZ32492ZMedicare PIN