Healthcare Provider Details

I. General information

NPI: 1720674484
Provider Name (Legal Business Name): CHRISTIE ANGELIE TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ALICANTE AISLE
IRVINE CA
92614-8551
US

IV. Provider business mailing address

214 ALICANTE AISLE
IRVINE CA
92614-8551
US

V. Phone/Fax

Practice location:
  • Phone: 818-251-0652
  • Fax:
Mailing address:
  • Phone: 818-251-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95023830
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: