Healthcare Provider Details

I. General information

NPI: 1538652946
Provider Name (Legal Business Name): HOANG JUNE TANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT 2799 W. GRAND BOULEVARD
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT 2799 W. GRAND BOULEVARD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2600
  • Fax:
Mailing address:
  • Phone: 313-916-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2023-02499
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82677
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: