Provider Demographics
NPI:1316441181
Name:TANG, MAYCKY (DO)
Entity type:Individual
Prefix:
First Name:MAYCKY
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 UNIVERSITY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3315
Mailing Address - Country:US
Mailing Address - Phone:184-482-7800
Mailing Address - Fax:
Practice Address - Street 1:1303 E HERNDON AVE STE 850
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3309
Practice Address - Country:US
Practice Address - Phone:559-450-5672
Practice Address - Fax:559-450-7470
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19140207RC0200X
CA19140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine