Provider Demographics
NPI:1588976880
Name:TSENG, JEFFREY (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:TSENG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 SKYPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5394
Mailing Address - Country:US
Mailing Address - Phone:310-326-8551
Mailing Address - Fax:310-326-3363
Practice Address - Street 1:2780 SKYPARK DR STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5394
Practice Address - Country:US
Practice Address - Phone:310-326-8551
Practice Address - Fax:310-326-3363
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL1818213ES0103X
CAE5014213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGG631AMedicare PIN