Healthcare Provider Details

I. General information

NPI: 1487563870
Provider Name (Legal Business Name): XIN TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21110 MERIDIAN E STE E3
GRAHAM WA
98338-5706
US

IV. Provider business mailing address

34816 1ST AVE S APT A521
FEDERAL WAY WA
98003-6984
US

V. Phone/Fax

Practice location:
  • Phone: 253-559-1660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.70155258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: