Provider Demographics
NPI:1609651272
Name:SAN DAO TANG LLC
Entity Type:Organization
Organization Name:SAN DAO TANG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FANGDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-318-4988
Mailing Address - Street 1:1788 SIERRA LEONE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-5890
Mailing Address - Country:US
Mailing Address - Phone:626-318-4988
Mailing Address - Fax:
Practice Address - Street 1:1788 SIERRA LEONE AVE STE 105
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-5890
Practice Address - Country:US
Practice Address - Phone:626-318-4988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty