Healthcare Provider Details

I. General information

NPI: 1548233638
Provider Name (Legal Business Name): JULIAN H TANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RAYMOND DR SUITE 205
NAPERVILLE IL
60563-9789
US

IV. Provider business mailing address

636 RAYMOND DR SUITE 205
NAPERVILLE IL
60563-9789
US

V. Phone/Fax

Practice location:
  • Phone: 630-717-2300
  • Fax: 630-717-9638
Mailing address:
  • Phone: 630-717-2300
  • Fax: 630-717-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberA104067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47798
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036128594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: