Healthcare Provider Details

I. General information

NPI: 1174866412
Provider Name (Legal Business Name): HSUANTING TANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1800 E OLD RANCH RD APT 158
COLTON CA
92324-6465
US

IV. Provider business mailing address

1800 E OLD RANCH RD APT 158
COLTON CA
92324-6465
US

V. Phone/Fax

Practice location:
  • Phone: 909-965-5117
  • Fax:
Mailing address:
  • Phone: 909-965-5117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. HSUANTING TANG
Title or Position: REGISTERED DIETITIAN
Credential: MS, RD
Phone: 909-965-5117