Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 123EXAMPLE | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 123EXAMPLE | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 123EXAMPLE | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 123EXAMPLE | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 123EXAMPLE | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 123EXAMPLE | CA |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 123EXAMPLE | CA |
NPI | 1396263604 |
---|---|
Provider Name | Mr. Alexander Lynn Tang |
First Address | Santa Ana, CA 92704 |
Second Address | Santa Ana, CA 92704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 14/03/2019 |