Provider Demographics
NPI:1760042022
Name:TANG, DEREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SUNNYVALE SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4571
Mailing Address - Country:US
Mailing Address - Phone:408-732-1204
Mailing Address - Fax:
Practice Address - Street 1:1555 SUNNYVALE SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4571
Practice Address - Country:US
Practice Address - Phone:408-732-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice