Healthcare Provider Details

I. General information

NPI: 1164632527
Provider Name (Legal Business Name): CHARLES BRIAN TANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PACIFIC AVE
LONG BEACH CA
90813-3026
US

IV. Provider business mailing address

1250 PACIFIC AVE
LONG BEACH CA
90813-3026
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-0831
  • Fax: 562-628-9393
Mailing address:
  • Phone: 562-437-0831
  • Fax: 562-628-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA26145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: