Provider Demographics
NPI:1376667931
Name:TANG, PHUONG (LCSW)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W OLYMPIC BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1475
Mailing Address - Country:US
Mailing Address - Phone:213-553-1800
Mailing Address - Fax:
Practice Address - Street 1:605 W OLYMPIC BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1475
Practice Address - Country:US
Practice Address - Phone:213-553-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical