Provider Demographics
NPI:1841956737
Name:TANG, KENNY
Entity type:Individual
Prefix:
First Name:KENNY
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 1:2409 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5353
Practice Address - Country:US
Practice Address - Phone:408-247-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2024-11-20
Deactivation Date:2023-02-25
Deactivation Code:
Reactivation Date:2023-09-25
Provider Licenses
StateLicense IDTaxonomies
TX70664183500000X
CA87028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87028OtherPHARM TECH LICENSE PHARMACIST