Provider Demographics
NPI:1154327773
Name:ASHLEY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ASHLEY MEDICAL GROUP, INC
Other - Org Name:ASHLEY TANG MD, ASHLEY MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-248-0073
Mailing Address - Street 1:4000 14TH ST
Mailing Address - Street 2:STE 213
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4009
Mailing Address - Country:US
Mailing Address - Phone:951-248-0073
Mailing Address - Fax:951-248-0075
Practice Address - Street 1:4000 14TH ST
Practice Address - Street 2:STE 213
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4009
Practice Address - Country:US
Practice Address - Phone:951-248-0073
Practice Address - Fax:951-248-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A601950Medicaid
CABT5328225OtherDEA
CA00A601950Medicaid
CABT5328225OtherDEA
G63864Medicare UPIN