Basic Information
Provider Information
NPI: 1487742003
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TSANG
FirstName: NALLY
MiddleName: LIN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 DISTEL CIR
Address2:  
City: LOS ALTOS
State: CA
PostalCode: 940221408
CountryCode: US
TelephoneNumber: 5104901222
FaxNumber:  
Practice Location
Address1: 3200 KEARNEY STREET
Address2:  
City: FREMONT
State: CA
PostalCode: 945382299
CountryCode: US
TelephoneNumber: 5104901222
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/10/2006
LastUpdateDate: 05/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA76823CAN Allopathic & Osteopathic PhysiciansPediatrics 
207R00000XA76823CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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