Healthcare Provider Details

I. General information

NPI: 1083732382
Provider Name (Legal Business Name): HONG-MING TANG D.D.S. M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1039
US

IV. Provider business mailing address

824 N DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1039
US

V. Phone/Fax

Practice location:
  • Phone: 909-612-4666
  • Fax: 909-612-4676
Mailing address:
  • Phone: 909-612-4666
  • Fax: 909-612-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number45031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: