Provider Demographics
NPI:1023097144
Name:TSAO, KUANG-WEN (MD)
Entity type:Individual
Prefix:
First Name:KUANG-WEN
Middle Name:
Last Name:TSAO
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 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4720
Mailing Address - Fax:860-358-6741
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3654
Practice Address - Country:US
Practice Address - Phone:860-358-4720
Practice Address - Fax:860-358-6741
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042991208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDING CLAIMOtherRR MEDICARE
CT61470493OtherUHC
CT7059614OtherAETNA
CT01405528OtherCOVENTRY
CT042991OtherCT LICENSE
CT05898265OtherCIGNA
CT61470493OtherOXFORD
CT042991OtherCT LICENSE
CT7059614OtherAETNA