Provider Demographics
NPI:1700069630
Name:TANG, TUNG HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:TUNG
Middle Name:HENRY
Last Name:TANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:TUNG
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2650 JONES WAY STE 30
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1221
Mailing Address - Country:US
Mailing Address - Phone:805-579-9999
Mailing Address - Fax:805-579-9900
Practice Address - Street 1:2650 JONES WAY STE 30
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1221
Practice Address - Country:US
Practice Address - Phone:805-579-9999
Practice Address - Fax:805-579-9900
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A90242084N0008X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology