Healthcare Provider Details

I. General information

NPI: 1023695814
Provider Name (Legal Business Name): SHI TANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 WEST MAIN ST STE C #160
ALHAMBRA CA
91801-3376
US

IV. Provider business mailing address

560 W MAIN ST STE C
ALHAMBRA CA
91801-3376
US

V. Phone/Fax

Practice location:
  • Phone: 840-465-2899
  • Fax:
Mailing address:
  • Phone: 840-465-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: