Provider Demographics
NPI:1134302409
Name:TANG, SUJIE (MD)
Entity Type:Individual
Prefix:
First Name:SUJIE
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 VAN NUYS BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1700
Mailing Address - Country:US
Mailing Address - Phone:818-616-3998
Mailing Address - Fax:818-688-0138
Practice Address - Street 1:4940 VAN NUYS BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-616-3998
Practice Address - Fax:818-688-0138
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107300207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA107300OtherSTATE LICENSE
CAA107300OtherSTATE LICENSE
CA7525580001Medicare NSC