Provider Demographics
NPI:1245247048
Name:TANG, ROBERT EDWARD (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:TANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 JENEVEIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4408
Mailing Address - Country:US
Mailing Address - Phone:650-588-9189
Mailing Address - Fax:650-588-2814
Practice Address - Street 1:560 JENEVEIN AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4408
Practice Address - Country:US
Practice Address - Phone:650-588-9189
Practice Address - Fax:650-588-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3983213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U61109Medicare UPIN