Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MT213438 | PA |
NPI | 1033630892 |
---|---|
Provider Name | Jessica Anne Tang |
First Address | Philadelphia, PA 19140-5104 |
Second Address | Philadelphia, PA 19140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 03/07/2017 |