Healthcare Provider Details

I. General information

NPI: 1609022383
Provider Name (Legal Business Name): RONALD TANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 310
PASADENA CA
91105-4000
US

IV. Provider business mailing address

541 W COLORADO ST STE 205
GLENDALE CA
91204-3640
US

V. Phone/Fax

Practice location:
  • Phone: 626-288-0008
  • Fax: 866-741-4630
Mailing address:
  • Phone: 323-254-0046
  • Fax: 323-488-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20A11008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: