Healthcare Provider Details

I. General information

NPI: 1396263604
Provider Name (Legal Business Name): MR. ALEXANDER LYNN TANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 SAN LORENZO
SANTA ANA CA
92704
US

IV. Provider business mailing address

2306 SAN LORENZO
SANTA ANA CA
92704
US

V. Phone/Fax

Practice location:
  • Phone: 714-675-0229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number123EXAMPLE
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number123EXAMPLE
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number123EXAMPLE
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123EXAMPLE
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number123EXAMPLE
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number123EXAMPLE
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number123EXAMPLE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: