Provider Demographics
NPI:1669455655
Name:TANG, CHIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIN
Middle Name:C
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1070
Mailing Address - Fax:718-661-7401
Practice Address - Street 1:56-45 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:646-385-3575
Practice Address - Fax:718-661-7401
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221060207R00000X
NY252089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2065371Medicaid
MA2065371Medicaid
MAH75705Medicare UPIN