Provider Demographics
NPI:1366023509
Name:TANG, MADELINE HAE-HEE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:HAE-HEE
Last Name:TANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 MARINER DR APT A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3374
Mailing Address - Country:US
Mailing Address - Phone:408-605-6242
Mailing Address - Fax:
Practice Address - Street 1:921 MARINER DR APT A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-3374
Practice Address - Country:US
Practice Address - Phone:408-605-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95074638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse