Provider Demographics
NPI:1609373448
Name:TANG, GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5085
Mailing Address - Country:US
Mailing Address - Phone:661-222-9392
Mailing Address - Fax:661-222-9187
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 115
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5085
Practice Address - Country:US
Practice Address - Phone:661-222-9392
Practice Address - Fax:661-222-9187
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty