Provider Demographics
NPI:1013440346
Name:TANG, JENNY XIN YI
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:XIN YI
Last Name:TANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7298 197 STREET
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V2Y 3E6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8090 GUIDE MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9210
Practice Address - Country:US
Practice Address - Phone:360-354-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60722032390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program