Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G75213 | CA |
NPI | 1093729691 |
---|---|
Provider Name | Dr. Eddie Tang |
First Address | San Francisco, CA 94117-1078 |
Second Address | San Francisco, CA 94117-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71310 | (02) | CA |
G752130 | (05) | CA |
G752130 | BLUE CROSS/BLUE SHIELD (01) | CA |