Provider Demographics
NPI:1851309819
Name:TANG, MIAO-KUANG (MD)
Entity Type:Individual
Prefix:
First Name:MIAO-KUANG
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 KISSENA BILV
Mailing Address - Street 2:APT 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3221
Mailing Address - Country:US
Mailing Address - Phone:718-353-2820
Mailing Address - Fax:718-353-3846
Practice Address - Street 1:4211 KISSENA BLVD
Practice Address - Street 2:APT 1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3221
Practice Address - Country:US
Practice Address - Phone:718-353-2820
Practice Address - Fax:718-353-3846
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19678001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01532723Medicaid