MEDICARE: DR. DENGDA TANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	25MA07723200	NJ
2	208M00000X	Hospitalist Physician	25MA07723200	NJ
3	207RG0100X	Gastroenterology Physician	MD00049193	WA
4	207R00000X	Internal Medicine Physician	25MA07723200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467447821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENGDA TANG MD

Provider Business Mailing Address
First Line	:	125 16TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-5211
Country	:	US
Telephone Number	:	206-326-2529
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 NE 87TH AVE STE 301
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1965
Country	:	US
Telephone Number	:	360-514-7060
Fax Number	:	360-514-7068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	04/11/2024

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Directions to “ DR. DENGDA TANG MD” Practice Location

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