1720674484 NPI number — CHRISTIE ANGELIE TANG

Table of content: CHRISTIE ANGELIE TANG (NPI 1720674484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720674484 NPI number — CHRISTIE ANGELIE TANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANG
Provider First Name:
CHRISTIE ANGELIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720674484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 ALICANTE AISLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92614-8551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-251-0652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 ALICANTE AISLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92614-8551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-251-0652
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WG0000X , with the licence number:  95023830 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 95001465 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95001465 . This is a "BRN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 134684 . This is a "NBCRNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 95023830 . This is a "BRN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".