Healthcare Provider Details

I. General information

NPI: 1033346978
Provider Name (Legal Business Name): LAWTON W TANG MD MEDICAL COPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N RAYMOND AVE STE 212
PASADENA CA
91103-4535
US

IV. Provider business mailing address

125 N RAYMOND AVE STE 212
PASADENA CA
91103-4535
US

V. Phone/Fax

Practice location:
  • Phone: 626-766-6970
  • Fax: 626-403-0311
Mailing address:
  • Phone: 626-766-6970
  • Fax: 626-403-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWTON W TANG
Title or Position: CEO
Credential: MD
Phone: 626-766-6970