Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 76464 | KS |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95003889 | CA |
NPI | 1003221102 |
---|---|
Provider Name | Shuk Fong Tang |
First Address | San Francisco, CA 94111-3723 |
Second Address | San Jose, CA 95131-2020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2014 |
Last Update Date | 03/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201101110A | (05) | KS |