Healthcare Provider Details

I. General information

NPI: 1588042444
Provider Name (Legal Business Name): THINH TIEN TANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SIERRA ROSE DR
RENO NV
89511-2060
US

IV. Provider business mailing address

655 SIERRA ROSE DR
RENO NV
89511-2060
US

V. Phone/Fax

Practice location:
  • Phone: 775-600-4717
  • Fax: 775-829-3757
Mailing address:
  • Phone: 775-600-4717
  • Fax: 775-829-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDO2338
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: