Individual provider Active NPI

Astin Tan-Nam Lequang, DDS

  • General Practice Dentistry
  • Norfolk, VA
National Provider Identifier
1164314902
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14227683-9926 Issued in UT
Practice address
1647 Admiral Taussig Blvd
Norfolk, VA 23511-2803
Phone
(757) 953-8635
NPI assigned
Jul 16, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14227683-9926 UT Primary

Addresses

Primary practice location

1647 Admiral Taussig Blvd
Norfolk, VA 23511-2803

Mailing address

3100 De Forest Rd Unit 186
Marina, CA 93933-5308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
14227683-9926UTMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1164314902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 DE FOREST RD UNIT 186",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939335308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 ADMIRAL TAUSSIG BLVD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235112803",
            "telephone_number": "757-953-8635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEQUANG",
        "first_name": "ASTIN",
        "middle_name": "TAN-NAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "14227683-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.