Healthcare Provider Details

I. General information

NPI: 1225635147
Provider Name (Legal Business Name): YAT T. TANG, DDS, MS, PHD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 10/04/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 EUREKA WAY STE 1
REDDING CA
96001-0157
US

IV. Provider business mailing address

1884 BRUSH DR
CARSON CITY NV
89703-7430
US

V. Phone/Fax

Practice location:
  • Phone: 530-243-3300
  • Fax: 530-246-9174
Mailing address:
  • Phone: 626-863-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YAT TO TANG
Title or Position: ORTHODONTIST
Credential: DDS, MS, PHD
Phone: 626-863-5724