Healthcare Provider Details

I. General information

NPI: 1003659798
Provider Name (Legal Business Name): SOPHIA SHEN RUEY TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 N GARFIELD AVE STE 203
MONTEREY PARK CA
91754-1153
US

IV. Provider business mailing address

308 OXFORD DR
ARCADIA CA
91007-2641
US

V. Phone/Fax

Practice location:
  • Phone: 626-635-1688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA67886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: