Provider Demographics
NPI:1174904312
Name:TSAI, JESSICA SUN (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUN
Last Name:TSAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 VERDUGO BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3024
Mailing Address - Country:US
Mailing Address - Phone:818-637-7980
Mailing Address - Fax:818-637-7985
Practice Address - Street 1:1975 VERDUGO BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3024
Practice Address - Country:US
Practice Address - Phone:818-637-7980
Practice Address - Fax:818-637-7985
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics