Healthcare Provider Details

I. General information

NPI: 1417160359
Provider Name (Legal Business Name): JOYCE WING-YI TANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC5000
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1111
  • Fax: 773-702-2859
Mailing address:
  • Phone: 773-702-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036117634
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-117634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: