Healthcare Provider Details

I. General information

NPI: 1194352575
Provider Name (Legal Business Name): PRISCILLA JOY TANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 HIGHLAND PIKE STE 1
FT WRIGHT KY
41017-8127
US

IV. Provider business mailing address

1945 HIGHLAND PIKE STE 1
FT WRIGHT KY
41017-8127
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-4005
  • Fax: 859-331-4606
Mailing address:
  • Phone: 859-331-4005
  • Fax: 859-331-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58015
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: