Provider Demographics
NPI:1407229040
Name:TANG, CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E 30 N
Mailing Address - Street 2:ROOM 4B319
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-6390
Mailing Address - Fax:801-585-3377
Practice Address - Street 1:1900 E 30 N
Practice Address - Street 2:ROOM 4B319
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-6390
Practice Address - Fax:801-585-3377
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT95435871206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant