Healthcare Provider Details

I. General information

NPI: 1689161929
Provider Name (Legal Business Name): SARAH NGOCVI TANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

IV. Provider business mailing address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7301
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11414315-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: