Provider Demographics
NPI:1053307033
Name:TANG, DANIEL STEPHENSON (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:STEPHENSON
Last Name:TANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-7131
Mailing Address - Fax:323-255-9928
Practice Address - Street 1:5835 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2634
Practice Address - Country:US
Practice Address - Phone:323-255-7131
Practice Address - Fax:323-255-9928
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117520Medicaid
CA11752TOtherLICENSE #
CAMT0958237OtherDEA #
CA11752TOtherLICENSE #
CASD0117520Medicaid