Provider Demographics
NPI:1750441044
Name:TANG, VIVIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 PINE STREET APT. 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10810 SAN PABLO AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2399
Practice Address - Country:US
Practice Address - Phone:510-528-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist