Provider Demographics
NPI:1073277828
Name:TANG, LEIA BINH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LEIA
Middle Name:BINH
Last Name:TANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAY
Other - Middle Name:BINH
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12462 PUTNAM ST STE 501
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1049
Mailing Address - Country:US
Mailing Address - Phone:562-789-5439
Mailing Address - Fax:562-789-4443
Practice Address - Street 1:12462 PUTNAM ST STE 501
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1049
Practice Address - Country:US
Practice Address - Phone:562-789-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA60741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant