Provider Demographics
NPI:1205128071
Name:TANG, ANDREW (LAC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W BASTANCHURY RD
Mailing Address - Street 2:#C
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2525
Mailing Address - Country:US
Mailing Address - Phone:626-377-8508
Mailing Address - Fax:
Practice Address - Street 1:105 W BASTANCHURY RD
Practice Address - Street 2:#C
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2525
Practice Address - Country:US
Practice Address - Phone:626-377-8508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13353171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist