Healthcare Provider Details

I. General information

NPI: 1467447821
Provider Name (Legal Business Name): DENGDA TANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 301
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

125 16TH AVE E
SEATTLE WA
98112-5211
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7060
  • Fax: 360-514-7068
Mailing address:
  • Phone: 206-326-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07723200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00049193
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA07723200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA07723200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: