Provider Demographics
NPI:1639573496
Name:TANG, THUHONG THI
Entity Type:Individual
Prefix:
First Name:THUHONG
Middle Name:THI
Last Name:TANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 MONTEREY HWY SPC 195
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6046
Mailing Address - Country:US
Mailing Address - Phone:408-931-1325
Mailing Address - Fax:
Practice Address - Street 1:2150 MONTEREY HWY SPC 195
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6046
Practice Address - Country:US
Practice Address - Phone:408-931-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282817374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide