Provider Demographics
NPI:1871199596
Name:TANG, VICTOR KEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:KEN
Last Name:TANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 E LAKE MEAD BLVD APT 1049
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-1150
Mailing Address - Country:US
Mailing Address - Phone:415-608-9788
Mailing Address - Fax:
Practice Address - Street 1:4461 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5537
Practice Address - Country:US
Practice Address - Phone:702-791-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0018209183500000X
CA82954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist