Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A75460 | CA |
Y | 208600000X | Surgeon | A75460 | CA |
N | 2086S0102X | Surgical Critical Care | 00A754600 | CA |
N | 2086S0127X | Trauma Surgeon | 00A754600 | CA |
NPI | 1356325104 |
---|---|
Provider Name | Dr. Glenn Sau-Shun Tse |
First Address | Roseville, CA 95661-3027 |
Second Address | Roseville, CA 95661-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A754600 | (05) | CA |
I08184 | (02) | CA |