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General NPI Number Information
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NPI Number | 1508592759
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Entity Type | Individual
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Provider Name | SYDNEY JAO TANG PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 1505 WILSON TER STE 240
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City | GLENDALE
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State | CA
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Zip | 91206-4033
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Country | US
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Telephone | 310-205-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 204 DOVE CREEK LN
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City | DANVILLE
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State | CA
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Zip | 94506-1359
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Country | US
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Telephone | 925-788-9593
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 61272
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License Number State | CA
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