Healthcare Provider Details

I. General information

NPI: 1750726899
Provider Name (Legal Business Name): STEPHANIE TANG MARR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE WING-YAN TANG D.O.

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 N SEPULVEDA BLVD
MISSION HILLS CA
91345-1116
US

IV. Provider business mailing address

PO BOX 9606
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 818-869-7256
  • Fax: 818-869-7133
Mailing address:
  • Phone: 213-394-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A15362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number191640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: