Provider Demographics
NPI:1881917904
Name:TANG, TAI (LVN)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13104 GLEN CT
Mailing Address - Street 2:UNIT 67
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1123
Mailing Address - Country:US
Mailing Address - Phone:626-893-4487
Mailing Address - Fax:
Practice Address - Street 1:13104 GLEN CT
Practice Address - Street 2:UNIT 67
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1123
Practice Address - Country:US
Practice Address - Phone:626-893-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 235538164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse