Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 27175 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 27175 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 27175 | CA |
NPI | 1538393343 |
---|---|
Provider Name | Dr. Derrick Tang |
First Address | Beverly Hills, CA 90211-3324 |
Second Address | Beverly Hills, CA 90211-3324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2009 |
Last Update Date | 03/11/2015 |