Provider Demographics
NPI:1144365396
Name:TANG, MAI (OD)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5365 GRANBY DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3712
Mailing Address - Country:US
Mailing Address - Phone:714-925-2552
Mailing Address - Fax:714-278-9075
Practice Address - Street 1:1893 W MALVERN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2403
Practice Address - Country:US
Practice Address - Phone:714-925-2552
Practice Address - Fax:714-278-9075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10595T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD105952Medicaid
CAU93942Medicare UPIN
CAOP10595Medicare ID - Type Unspecified