Individual provider Active NPI

Jennifer Tang, DMD

  • General Practice Dentistry
  • Pacific Palisades, CA
National Provider Identifier
1407338916
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS103085 Issued in CA
Practice address
16939 Livorno Dr
Pacific Palisades, CA 90272-3230
Phone
(646) 206-2272
NPI assigned
Aug 30, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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 DDS103085 CA Primary

Addresses

Primary practice location

16939 Livorno Dr
Pacific Palisades, CA 90272-3230

Mailing address

16939 Livorno Dr
Pacific Palisades, CA 90272-3230
Phone (646) 206-2272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181107002869 CA Order and Referring Only - DentistPractitioner - Dentist 3678827755

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS103085CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Tang & Wong Dental, Inc General Practice Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1407338916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16939 LIVORNO DR",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723230",
            "telephone_number": "646-206-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16939 LIVORNO DR",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723230",
            "telephone_number": "646-206-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANG",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-30",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS103085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacific Palisades, CA

Sources for this page

Verify at the official NPI Registry.