Provider Demographics
NPI:1093728792
Name:TANG, LAWRENCE DAGANG (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAGANG
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAGANG
Other - Middle Name:
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1621622085B0100X, 2085R0202X
WAMD000463042085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210319OtherL&I-TRA KING CTY
WA0210318OtherL&I-UNION AVE OPEN MRI
WA1090797Medicaid
WA0210320OtherL&I-TRA REST OF WA
OR218351Medicaid
WA0394427OtherL&I-DIAGNOSTIC IMAGING NW
WAG8898629OtherPTAN-WESTERN STATE HOSPITAL
WAP00373378OtherRR MEDICARE-TRA
WA0210319OtherLABOR AND INDUSTRIES-TRA
WAG8896719OtherPTAN-DOCTORS CLINIC 7
WA8862641OtherMEDICARE PIN-UNION AVENUE OPEN MRI
WA8951852OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WAG8896714OtherPTAN-DOCTORS CLINIC 2
WAP00476780OtherRR MEDICARE-UNION AVENUE OPEN MRI
WA8862643OtherMEDICARE PIN-TRA KING
WAG8891300OtherPTAN-DOCTORS CLINIC
WAG8896716OtherPTAN-DOCTORS CLINIC 4
WAG8896715OtherPTAN-DOCTORS CLINIC 3
WAG8896718OtherPTAN-DOCTORS CLINIC 6
WA0210318OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA0210319OtherLABOR AND INDUSTRIES-TRA