Healthcare Provider Details

I. General information

NPI: 1346096567
Provider Name (Legal Business Name): CHRISTINA THIEN KIM TANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 40TH ST RM 602
NEW YORK NY
10016-1243
US

IV. Provider business mailing address

2 CRYSTAL BROOK CT
NESCONSET NY
11767-1766
US

V. Phone/Fax

Practice location:
  • Phone: 646-362-3368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number064734-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: