Provider Demographics
NPI:1639176282
Name:TANG, ANDREW HO KEUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HO KEUNG
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6207
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:155 HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-9816
Practice Address - Country:US
Practice Address - Phone:775-589-8900
Practice Address - Fax:775-588-7110
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54689207R00000X
NV8365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G53792Medicare UPIN
CA00A546890Medicare PIN
NV1639176282Medicaid
NVV100698Medicare PIN
CA1639176282Medicaid