Provider Demographics
NPI:1447216510
Name:TANG, BILL W (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:W
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 S. SUNSET,
Mailing Address - Street 2:#206
Mailing Address - City:W. COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3964
Mailing Address - Country:US
Mailing Address - Phone:626-338-3788
Mailing Address - Fax:626-962-0312
Practice Address - Street 1:1135 S. SUNSET,
Practice Address - Street 2:#206
Practice Address - City:W. COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-338-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433580Medicaid
CA00A433580Medicaid
CAA43358Medicare ID - Type Unspecified