Provider Demographics
NPI:1417153933
Name:TANG, YUNJIA (MD)
Entity Type:Individual
Prefix:DR
First Name:YUNJIA
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 1:7592 METROPOLITAN DR STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4428
Mailing Address - Country:US
Mailing Address - Phone:619-297-4900
Mailing Address - Fax:
Practice Address - Street 1:7592 METROPOLITAN DR STE 405
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4428
Practice Address - Country:US
Practice Address - Phone:619-297-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53299-20207ZP0102X
NY242769207ZP0102X
CAC174282207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI141753933OtherBCBS
WI100004694Medicaid
WI525100072Medicare PIN
WI100004694Medicaid
WI070450065Medicare PIN
WI651900071Medicare PIN
WI020450070Medicare PIN