Provider Demographics
NPI:1194743864
Name:TSI, SY (MD)
Entity type:Individual
Prefix:
First Name:SY
Middle Name:
Last Name:TSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIVIXAY
Other - Middle Name:SY
Other - Last Name:SAYASACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 S. MAIN ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-735-2700
Mailing Address - Fax:951-256-8255
Practice Address - Street 1:801 S. MAIN ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:951-735-2700
Practice Address - Fax:951-256-8255
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74951208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A749510Medicaid
H39067Medicare UPIN
00A749510Medicare ID - Type Unspecified