Healthcare Provider Details

I. General information

NPI: 1073277828
Provider Name (Legal Business Name): LEIA BINH TANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAY BINH TANG PA-C

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

IV. Provider business mailing address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5439
  • Fax:
Mailing address:
  • Phone: 562-789-5439
  • Fax: 562-789-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: