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General NPI Number Information
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NPI Number | 1750441044
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Entity Type | Individual
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Provider Name | VIVIAN TANG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 10810 SAN PABLO AVE SUITE 30
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City | EL CERRITO
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State | CA
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Zip | 94530-2399
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Country | US
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Telephone | 510-528-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 1166 PINE STREET APT. 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94109
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 55017
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License Number State | CA
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