Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | A2010730 | CA |
NPI | 1023245198 |
---|---|
Provider Name | Chin Tang |
First Address | Long Beach, CA 90814-1764 |
Second Address | Long Beach, CA 90814-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 28/08/2019 |