Basic Information
| Provider Information | |||||||||
| NPI: | 1740556364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANG | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 NW 10TH AVE # 2023A | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436735 | ||||||||
| FaxNumber: | 3052436191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 NW 12TH AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052433380 | ||||||||
| FaxNumber: | 3052434184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | ME133086 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.