Healthcare Provider Details

I. General information

NPI: 1952669285
Provider Name (Legal Business Name): XIANNAN XANDER TANG MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: XANDER TANG MD PHD

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

757 WESTWOOD PLZ RM B711
LOS ANGELES CA
90095-1769
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-5009
  • Fax:
Mailing address:
  • Phone: 310-825-6681
  • Fax: 310-206-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA132121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: