Provider Demographics
NPI:1588756704
Name:LANG, JOHN A (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:LANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 18TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2470
Mailing Address - Country:US
Mailing Address - Phone:415-252-7522
Mailing Address - Fax:415-252-7522
Practice Address - Street 1:4200 18TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2470
Practice Address - Country:US
Practice Address - Phone:415-252-7522
Practice Address - Fax:415-252-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20276103TC0700X, 103G00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 20276OtherSTATE LICENSE
CAPSY 20276OtherSTATE LICENSE