Healthcare Provider Details

I. General information

NPI: 1053757195
Provider Name (Legal Business Name): VANESSA JOYCE TANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E BASELINE RD
TEMPE AZ
85283-1511
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 480-453-5000
  • Fax: 480-345-5266
Mailing address:
  • Phone: 623-277-1130
  • Fax: 866-837-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR73751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: