MEDICARE: DR. JOHN CUONG 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	207R00000X	Internal Medicine Physician	A70341	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	A70341	CA

General Provider Information

NPI Number	:	1437145042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CUONG TANG M.D

Provider Business Mailing Address
First Line	:	966 TWIN BROOK DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-4067
Country	:	US
Telephone Number	:	408-221-7184
Fax Number	:

Provider Business Practice Location Address
First Line	:	14410 BIG BASIN WAY
Second Line	:
City	:	SARATOGA
State	:	CA
Zip	:	95070-6010
Country	:	US
Telephone Number	:	408-221-7184
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/14/2015

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