Provider Demographics
NPI:1083728257
Name:TANG, DAVID CHAN (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHAN
Last Name:TANG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 FANNIN ST STE 5.020
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-5247
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST STE 5.020
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675961367500000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181802303Medicaid
TX072548OtherAANA
TXP00341800OtherRAILROAD MEDICARE
TX86661UOtherBLUE CROSS BLUE SHIELD
TX181802301Medicaid
TX8G7826Medicare ID - Type Unspecified
TX181802303Medicaid
TX181802304Medicare PIN