Provider Demographics
NPI:1316981277
Name:TSOU, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TSOU
Suffix:
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 1:3400 W BALL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3735
Mailing Address - Country:US
Mailing Address - Phone:714-827-1212
Mailing Address - Fax:714-827-0843
Practice Address - Street 1:3400 W BALL RD STE 103
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3735
Practice Address - Country:US
Practice Address - Phone:714-827-1212
Practice Address - Fax:714-827-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330872922174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A329270Medicaid
CAA32927OtherMEDICAL LICENSE
C01444Medicare UPIN
CAA32927Medicare ID - Type Unspecified