Healthcare Provider Details

I. General information

NPI: 1821589490
Provider Name (Legal Business Name): YEN KIM TANG PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2018
Last Update Date: 05/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

3404 VAN WIG AVE
BALDWIN PARK CA
91706-5454
US

V. Phone/Fax

Practice location:
  • Phone: 626-371-6114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3156470
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: