Healthcare Provider Details

I. General information

NPI: 1396371209
Provider Name (Legal Business Name): GING TANG HUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE STE 175
SOUTH PASADENA CA
91030-2683
US

IV. Provider business mailing address

625 FAIR OAKS AVE STE 175
SOUTH PASADENA CA
91030-2683
US

V. Phone/Fax

Practice location:
  • Phone: 626-598-3770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A21100
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: