Provider Demographics
NPI:1073658142
Name:TANG, MINH (OD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:
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 1:848 SAN DIEGO LN
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6219
Mailing Address - Country:US
Mailing Address - Phone:714-985-0978
Mailing Address - Fax:714-985-0978
Practice Address - Street 1:21739 S. AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-513-6900
Practice Address - Fax:310-513-1445
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11754T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist