Healthcare Provider Details

I. General information

NPI: 1194354175
Provider Name (Legal Business Name): SCOTT JAI TANGHE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

7 REPA DR
ESSEX JUNCTION VT
05452-3361
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2887
  • Fax:
Mailing address:
  • Phone: 802-318-8975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A23663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: