Healthcare Provider Details

I. General information

NPI: 1992927248
Provider Name (Legal Business Name): LAWTON WAI-CHOY TANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 626-529-3937
  • Fax: 626-470-9938
Mailing address:
  • Phone: 626-529-3937
  • Fax: 626-470-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA104375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: