Healthcare Provider Details

I. General information

NPI: 1033153572
Provider Name (Legal Business Name): QUINN VI TANG P.A., L.AC., DACM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

IV. Provider business mailing address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone: 323-653-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9256
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: