Provider Demographics
NPI:1316280407
Name:TSENG, JACK KWANGSAUAN (DO)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:KWANGSAUAN
Last Name:TSENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KWANG
Other - Middle Name:
Other - Last Name:TSENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:602 S HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2413
Mailing Address - Country:US
Mailing Address - Phone:813-253-2112
Mailing Address - Fax:
Practice Address - Street 1:602 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2413
Practice Address - Country:US
Practice Address - Phone:813-253-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine