Provider Demographics
NPI:1164648929
Name:TANG, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
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 1:3320 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-4119
Mailing Address - Country:US
Mailing Address - Phone:213-749-5386
Mailing Address - Fax:213-749-8592
Practice Address - Street 1:3320 S. HILL STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:213-749-5386
Practice Address - Fax:213-749-8592
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43942207P00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43942OtherSTATE MEDICAL LICENSE