Provider Demographics
NPI:1093729691
Name:TANG, EDDIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:STE 204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1078
Mailing Address - Country:US
Mailing Address - Phone:415-387-9992
Mailing Address - Fax:415-387-9996
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-387-9992
Practice Address - Fax:415-387-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75213208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG752130Medicaid
CAG752130OtherBLUE CROSS/BLUE SHIELD
CAG752130Medicaid
CAG71310Medicare UPIN