Provider Demographics
NPI:1194498071
Name:TANG & WONG DENTAL, INC
Entity type:Organization
Organization Name:TANG & WONG DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-315-1142
Mailing Address - Street 1:2336 SANTA MONICA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2093
Mailing Address - Country:US
Mailing Address - Phone:310-315-1142
Mailing Address - Fax:310-315-0640
Practice Address - Street 1:2336 SANTA MONICA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2093
Practice Address - Country:US
Practice Address - Phone:310-315-1142
Practice Address - Fax:310-315-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103085OtherDENTIST