Provider Demographics
NPI:1780934703
Name:TSAI, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TSAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17520 CASTLETON ST
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1701
Mailing Address - Country:US
Mailing Address - Phone:626-913-0042
Mailing Address - Fax:
Practice Address - Street 1:17520 CASTLETON ST
Practice Address - Street 2:SUITE 105A
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1701
Practice Address - Country:US
Practice Address - Phone:626-913-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28832156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASL3122OtherREGISTERED SPECTACLE LENS DISPENSER MEDICAL BOARD OF CA
CA28832OtherCERTIFIED OPTICIAN
CAB2943OtherCERTIFIED CONTACT LENS TECHNICIAN NATIONAL CONTACT LENS EXAMINER