Healthcare Provider Details

I. General information

NPI: 1699909036
Provider Name (Legal Business Name): HENRY H TANG DISPENSING OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 CLAY ST
SAN FRANCISCO CA
94108-1611
US

IV. Provider business mailing address

852 CLAY ST
SAN FRANCISCO CA
94108-1611
US

V. Phone/Fax

Practice location:
  • Phone: 415-397-9718
  • Fax: 415-397-0427
Mailing address:
  • Phone: 415-397-9718
  • Fax: 415-397-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL1918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: