Provider Demographics
NPI:1083244313
Name:DEREK H. TANG DDS INC.
Entity Type:Organization
Organization Name:DEREK H. TANG DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-839-1888
Mailing Address - Street 1:7601 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5243
Mailing Address - Country:US
Mailing Address - Phone:408-839-1888
Mailing Address - Fax:
Practice Address - Street 1:640 MILL ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1727
Practice Address - Country:US
Practice Address - Phone:650-726-7581
Practice Address - Fax:650-726-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental