Provider Demographics
NPI:1255851069
Name:TANG, SHIH CHIANG (LMFT)
Entity Type:Individual
Prefix:
First Name:SHIH CHIANG
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 CAMINO DEL RIO S STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4009
Mailing Address - Country:US
Mailing Address - Phone:619-787-6676
Mailing Address - Fax:
Practice Address - Street 1:11526 SORRENTO VALLEY RD STE F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1314
Practice Address - Country:US
Practice Address - Phone:619-800-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA128254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program