Provider Demographics
NPI:1477556454
Name:TANG, NIANJUN (MD)
Entity Type:Individual
Prefix:
First Name:NIANJUN
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 1:6064 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5350
Mailing Address - Country:US
Mailing Address - Phone:702-839-1203
Mailing Address - Fax:702-839-1301
Practice Address - Street 1:6064 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4534
Practice Address - Country:US
Practice Address - Phone:702-940-8007
Practice Address - Fax:702-832-1940
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11657208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200428340AMedicaid
IN200428340AMedicaid
INH80075Medicare UPIN