Provider Demographics
NPI:1730180050
Name:TSANG, THERESA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:TSANG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:SIU-YIN
Other - Middle Name:THERESA
Other - Last Name:TSANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD , PHD
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-899-3888
Mailing Address - Fax:425-899-1166
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 230
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-3888
Practice Address - Fax:425-899-1166
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028324207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1066927Medicaid
WATS1241OtherREGENCE RIDER #
WATS1241OtherREGENCE RIDER #
WAFO5392Medicare UPIN