Provider Demographics
NPI:1083788566
Name:TANG, LU (DDS)
Entity Type:Individual
Prefix:MS
First Name:LU
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 STORY RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1054
Mailing Address - Country:US
Mailing Address - Phone:408-928-6000
Mailing Address - Fax:408-928-6008
Practice Address - Street 1:2230 STORY RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1054
Practice Address - Country:US
Practice Address - Phone:408-928-6000
Practice Address - Fax:408-928-6008
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44100OtherCA