Healthcare Provider Details

I. General information

NPI: 1487588844
Provider Name (Legal Business Name): LIKHIM TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24363 KATRINA AVE
MORENO VALLEY CA
92551-3663
US

IV. Provider business mailing address

2411 W LA PALMA AVE
ANAHEIM CA
92801-2610
US

V. Phone/Fax

Practice location:
  • Phone: 951-581-5475
  • Fax:
Mailing address:
  • Phone: 714-876-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95312617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: