Healthcare Provider Details

I. General information

NPI: 1457514754
Provider Name (Legal Business Name): HAIWANG TANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 IOOF AVE
GILROY CA
95020-5204
US

IV. Provider business mailing address

324 NW 149TH TER
EDMOND OK
73013-2478
US

V. Phone/Fax

Practice location:
  • Phone: 408-846-2100
  • Fax:
Mailing address:
  • Phone: 405-535-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC162559
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number26531
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: