MEDICARE: SUJIE TANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	A107300	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A107300	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1134302409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJIE TANG M.D.

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD STE 207
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1700
Country	:	US
Telephone Number	:	818-616-3998
Fax Number	:	818-688-0138

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD STE 207
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1700
Country	:	US
Telephone Number	:	818-616-3998
Fax Number	:	818-688-0138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	07/29/2016

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Directions to “ SUJIE TANG M.D.” Practice Location

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