Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G83573 | CA |
NPI | 1063481588 |
---|---|
Provider Name | Dr. Gordon Tang |
First Address | Berkeley, CA 94705-2190 |
Second Address | Berkeley, CA 94705-2190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 05/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92077 | (02) | CA |