Provider Demographics
NPI:1184732901
Name:TSE, PHILLIP FOON (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:FOON
Last Name:TSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:373 S REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5109
Mailing Address - Country:US
Mailing Address - Phone:408-261-3739
Mailing Address - Fax:408-261-3737
Practice Address - Street 1:373 S. REDWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5109
Practice Address - Country:US
Practice Address - Phone:408-261-3739
Practice Address - Fax:408-261-3737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539000OtherMEDICARE PROVIDER NUMBER
CA00A539000Medicaid