Basic Information
| Provider Information | |||||||||
| NPI: | 1033346978 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAWTON W TANG MD MEDICAL COPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PREMIERE PLASTIC SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 N RAYMOND AVE STE 212 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911034535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267666970 | ||||||||
| FaxNumber: | 6264030311 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 N RAYMOND AVE STE 212 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911034535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267666970 | ||||||||
| FaxNumber: | 6264030311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | TANG | ||||||||
| AuthorizedOfficialFirstName: | LAWTON | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6267666970 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.