Provider Demographics
NPI:1902543614
Name:GRACE TSAI DPM PODIATRY INC
Entity Type:Organization
Organization Name:GRACE TSAI DPM PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-533-9070
Mailing Address - Street 1:3711 INGLEWOOD BLVD APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3260
Mailing Address - Country:US
Mailing Address - Phone:646-533-9070
Mailing Address - Fax:
Practice Address - Street 1:3711 INGLEWOOD BLVD APT 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3260
Practice Address - Country:US
Practice Address - Phone:646-533-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE TSAI DPM PODIATRY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-14
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty