Provider Demographics
NPI:1952669285
Name:TANG, XIANNAN XANDER (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:XIANNAN
Middle Name:XANDER
Last Name:TANG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:DR
Other - First Name:XANDER
Other - Middle Name:
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:757 WESTWOOD PLZ RM B711
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1769
Mailing Address - Country:US
Mailing Address - Phone:310-825-6681
Mailing Address - Fax:310-206-4733
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist