Provider Demographics
NPI:1194736082
Name:TSAO, JOHN M SR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:TSAO
Suffix:SR
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 1:20911 EARL ST STE 340
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4354
Mailing Address - Country:US
Mailing Address - Phone:310-542-6333
Mailing Address - Fax:310-542-4695
Practice Address - Street 1:20911 EARL ST STE 340
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4354
Practice Address - Country:US
Practice Address - Phone:310-542-6333
Practice Address - Fax:310-542-4695
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23235207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C232350Medicaid
CA1194736082Medicaid
CA1194736082Medicaid
CAA32343Medicare UPIN
CA00C232350Medicaid
CADS319XMedicare PIN