Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A78792 | CA |
NPI | 1366544629 |
---|---|
Provider Name | Dr. George Tang |
First Address | Pasadena, CA 91105 |
Second Address | Pasadena, CA 91105-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 07/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H68746 | (02) | CA |