MEDICARE: DR. VINCENT CUONG DUC 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	207Q00000X	Family Medicine Physician	A88190	CA
2	207P00000X	Emergency Medicine Physician	A88190	CA

General Provider Information

NPI Number	:	1578542957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT CUONG DUC TANG M.D

Provider Business Mailing Address
First Line	:	13672 YOAK ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-2734
Country	:	US
Telephone Number	:	714-270-5342
Fax Number	:

Provider Business Practice Location Address
First Line	:	13672 YOAK ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-2734
Country	:	US
Telephone Number	:	714-270-5342
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/06/2022

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