Provider Demographics
NPI:1700312402
Name:TANG, CHUN KIN
Entity Type:Individual
Prefix:
First Name:CHUN KIN
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 42ND ST
Mailing Address - Street 2:APT 19F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2014
Mailing Address - Country:US
Mailing Address - Phone:646-902-9191
Mailing Address - Fax:860-807-4967
Practice Address - Street 1:224 W 35TH ST STE 708
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2536
Practice Address - Country:US
Practice Address - Phone:646-902-9191
Practice Address - Fax:860-807-4967
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147090081103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service