Provider Demographics
NPI:1275849440
Name:TANG, KUN (MD)
Entity Type:Individual
Prefix:
First Name:KUN
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 1:3711 LANGLEY OAKS PL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4979
Mailing Address - Country:US
Mailing Address - Phone:864-633-8148
Mailing Address - Fax:
Practice Address - Street 1:126 ENTERPRISE PATH
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2656
Practice Address - Country:US
Practice Address - Phone:678-567-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC371602084P0800X
GA697242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA69724OtherLICENSE
SC37160OtherLICENSE