Provider Demographics
NPI:1902220148
Name:TANG, MINGHUI (DMD)
Entity Type:Individual
Prefix:
First Name:MINGHUI
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 WEST FULTON STREET
Mailing Address - Street 2:APT706
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2913
Mailing Address - Country:US
Mailing Address - Phone:312-738-0361
Mailing Address - Fax:
Practice Address - Street 1:4516 S. DAMEN AVE
Practice Address - Street 2:
Practice Address - City:IL
Practice Address - State:IL
Practice Address - Zip Code:60609-2913
Practice Address - Country:US
Practice Address - Phone:773-869-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030876122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program