Healthcare Provider Details

I. General information

NPI: 1124470448
Provider Name (Legal Business Name): RICHARD TANG-WAI MDCM, FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CAMPUS STREET COLEMAN PAVILLION, RM A1120
LOMA LINDA CA
92354
US

IV. Provider business mailing address

11175 CAMPUS STREET COLEMAN PAVILLION, RM A1120
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-8242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberC143221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: