Provider Demographics
NPI:1457538753
Name:TANG, JENNY NGOC (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:NGOC
Last Name:TANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 IRVINE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3361
Mailing Address - Country:US
Mailing Address - Phone:714-200-4774
Mailing Address - Fax:
Practice Address - Street 1:18001 IRVINE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3361
Practice Address - Country:US
Practice Address - Phone:714-200-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical