Provider Demographics
NPI:1295716108
Name:TSUI, PHILIP M L (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:M L
Last Name:TSUI
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:PO BOX 1275
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-0275
Mailing Address - Country:US
Mailing Address - Phone:626-282-5631
Mailing Address - Fax:626-282-3746
Practice Address - Street 1:25 S RAYMOND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3128
Practice Address - Country:US
Practice Address - Phone:626-282-5631
Practice Address - Fax:626-282-3746
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G621040Medicaid
CA00G621040Medicaid
CAG62104Medicare ID - Type Unspecified