1225635147 NPI number — YAT T. TANG, DDS, MS, PHD, INC.

Table of content: (NPI 1225635147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225635147 NPI number — YAT T. TANG, DDS, MS, PHD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAT T. TANG, DDS, MS, PHD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1225635147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1884 BRUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89703-7430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-863-5724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 EUREKA WAY STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-3300
Provider Business Practice Location Address Fax Number:
530-246-9174
Provider Enumeration Date:
10/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TANG
Authorized Official First Name:
YAT
Authorized Official Middle Name:
TO
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
626-863-5724

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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