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General NPI Number Information
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NPI Number | 1124158290
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Entity Type | Individual
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Provider Name | ALYSSA K TANG DDS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12400 EUCLID ST
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City | GARDEN GROVE
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State | CA
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Zip | 92840-3310
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Country | US
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Telephone | 714-537-1600
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Fax | 715-537-6512
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Provider Business Mailing Address
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Address Line | 12400 EUCLID ST
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City | GARDEN GROVE
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State | CA
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Zip | 92840-3310
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Country | US
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Telephone | 714-537-1600
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Fax | 715-537-6512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48582
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License Number State | CA
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