Provider Demographics
NPI:1265575799
Name:TSAI, DIANE B (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:TSAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:DIANE
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:4301 S PINE ST
Practice Address - Street 2:STE 301
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7264
Practice Address - Country:US
Practice Address - Phone:253-476-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003932101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8242893Medicaid
WA8242893Medicaid
WAG24023Medicare UPIN