Provider Demographics
NPI:1033346978
Name:LAWTON W TANG MD MEDICAL COPORATION
Entity Type:Organization
Organization Name:LAWTON W TANG MD MEDICAL COPORATION
Other - Org Name:PREMIERE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-766-6970
Mailing Address - Street 1:125 N RAYMOND AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-4535
Mailing Address - Country:US
Mailing Address - Phone:626-766-6970
Mailing Address - Fax:626-403-0311
Practice Address - Street 1:125 N RAYMOND AVE STE 212
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-4535
Practice Address - Country:US
Practice Address - Phone:626-766-6970
Practice Address - Fax:626-403-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE438AMedicare PIN