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1790987972 NPI number — CLARENCE SPENCER TANG DDS, MD

NPI Number: 1790987972
Health Care Provider/Practitioner: CLARENCE SPENCER TANG DDS, MD

Information about “1790987972” NPI (CLARENCE SPENCER TANG DDS, MD) exists in 1790987972 in HTML format HTML  |  1790987972 in plain Text format TXT  |  1790987972 in PDF (Portable Document Format) PDF  |  1790987972 in an XML format XML  formats.

NPI Number : 1790987972 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790987972",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TANG",
    "FirstName": "CLARENCE",
    "MiddleName": "SPENCER",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "DDS, MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10229 PRAIRIE SPRINGS RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92127-3421",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-769-5381",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13422 POMERADO RD STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POWAY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92064-3548",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-769-5381",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/01/2007",
    "LastUpdateDate": "11/30/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "109682",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "019.030300",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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