Basic Information
| Provider Information | |||||||||
| NPI: | 1669455655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANG | ||||||||
| FirstName: | CHIN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5645 MAIN ST | ||||||||
| Address2: | DEPARTMENT OF MEDICINE | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186701070 | ||||||||
| FaxNumber: | 7186617401 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 BELMONT ST | ||||||||
| Address2: | DEPARTMENT OF HOSPITAL MEDICINE | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083348515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 221060 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 252089 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2065371 | 05 | MA | MEDICAID |