Provider Demographics
NPI:1356923205
Name:KNIGHT, IRENE SU TANG (NP)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:SU TANG
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29370 LAS BRISAS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1533
Mailing Address - Country:US
Mailing Address - Phone:661-607-7737
Mailing Address - Fax:
Practice Address - Street 1:29370 LAS BRISAS RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91354-1533
Practice Address - Country:US
Practice Address - Phone:661-607-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner