Healthcare Provider Details

I. General information

NPI: 1992139141
Provider Name (Legal Business Name): TAMMY WAI-SUM TANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 HOOHUI ST
PEARL CITY HI
96782-2904
US

IV. Provider business mailing address

1348 HOOHUI ST
PEARL CITY HI
96782-2904
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number65500
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: