Healthcare Provider Details

I. General information

NPI: 1700535408
Provider Name (Legal Business Name): IRENA TANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 MEDICAL CENTER CT STE 300
CHULA VISTA CA
91911-6602
US

IV. Provider business mailing address

769 MEDICAL CENTER CT STE 300
CHULA VISTA CA
91911-6602
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-3090
  • Fax: 619-482-7350
Mailing address:
  • Phone: 619-482-3090
  • Fax: 619-482-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA187999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: