Provider Demographics
NPI:1861078503
Name:TANG, KENDI (DO)
Entity type:Individual
Prefix:DR
First Name:KENDI
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 OLD COUNTRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-2131
Mailing Address - Country:US
Mailing Address - Phone:516-742-8787
Mailing Address - Fax:
Practice Address - Street 1:393 OLD COUNTRY RD STE 200
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-2131
Practice Address - Country:US
Practice Address - Phone:516-742-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319982207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine