Provider Demographics
NPI:1083108310
Name:TIU, TONY WAI (PA-C)
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:WAI
Last Name:TIU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E COLORADO BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-6144
Mailing Address - Country:US
Mailing Address - Phone:626-244-8200
Mailing Address - Fax:
Practice Address - Street 1:680 E COLORADO BLVD STE 180
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6144
Practice Address - Country:US
Practice Address - Phone:626-244-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55930363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant