Provider Demographics
NPI:1952319022
Name:TANG, SHIU CHING (MD)
Entity Type:Individual
Prefix:
First Name:SHIU CHING
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 1:8708 JUSTICE AVE APT 1I
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4576
Mailing Address - Country:US
Mailing Address - Phone:718-478-8500
Mailing Address - Fax:718-478-8508
Practice Address - Street 1:8708 JUSTICE AVE APT 1I
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4576
Practice Address - Country:US
Practice Address - Phone:718-478-8500
Practice Address - Fax:718-478-8508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00223872Medicaid
NY00223872Medicaid
NY57139Medicare PIN