Healthcare Provider Details

I. General information

NPI: 1811459811
Provider Name (Legal Business Name): YICHENG TANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8038
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8038
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-3570
  • Fax:
Mailing address:
  • Phone: 949-365-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number179652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: