Provider Demographics
NPI:1265792543
Name:TANG, SIU WA (MD)
Entity type:Individual
Prefix:PROF
First Name:SIU
Middle Name:WA
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:N CAMPUS PSYCHIATRY ZOT 1681
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA IRVINE
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-1681
Mailing Address - Country:US
Mailing Address - Phone:949-824-3557
Mailing Address - Fax:
Practice Address - Street 1:N CAMPUS PSYCHIATRY ZOT 1681
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA IRVINE
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-1681
Practice Address - Country:US
Practice Address - Phone:949-824-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-048935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist