NIKKI DANIELLE YING TANG (NPI# 1740574169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740574169 |
| Entity Type | Individual |
| Full Name | NIKKI DANIELLE YING TANG |
| Credential | M.D. |
| Practice Address |
2924 Siskiyou Blvd Ste 200 Medford OR 97504-6462 |
| Practice Telephone | 5412002777 |
| Practice Fax Number | 5412142575 |
| Mailing Telephone | 5412002777 |
| Mailing Fax Number | 5412142575 |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2019-11-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | MD195049 | OR | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
2862881 | NY | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MD195049 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500766374 | 05 | |
| MD | 114347600 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2747 Crescent St Ste 206, Astoria, NY 111023142 | 7186268181 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598215022 | Nikki Borah Tang | Physician Assistant | 7 Blanchard Cir, Wheaton, IL 60189-7850 | 2016-10-07 |
| Street Address |
2924 SISKIYOU BLVD STE 200 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-6462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932346095 | Elena Tovkan Forster | Physician Assistant | 2924 Siskiyou Blvd Ste 200, Medford, OR 97504 | 2009-01-12 |
| 1467908863 | Clinic for Dermatology & Wellness LLC | Physician Assistant | 2924 Siskiyou Blvd Ste 200, Medford, OR 97504-6462 | 2016-08-26 |
| 1164700738 | Kevin Wright | Dermatology | 2924 Siskiyou Blvd Ste 200, Medford, OR 97504-6462 | 2011-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871574947 | Edgar Maeyens | Dermatology | 375 Park Ave, Suite 5, Coos Bay, OR 97420-2242 | 2005-11-07 |
| 1447713573 | Dermatology Health Specialists, PC | Dermatology | 1693 Sw Chandler Ave Ste 250, Bend, OR 97702-3231 | 2019-04-06 |
| 1972913259 | Lindsey Fix | Dermatology | 1605 G St, Springfield, OR 97477 | 2014-05-07 |
| 1558515494 | Jay Y Park Md, PC | Dermatology | 360 S Garden Way Ste 230, Eugene, OR 97401-8173 | 2008-11-05 |
| 1780846501 | Bend Memorial Clinic PC | Dermatology | 2600 Ne Neff Rd, Bend, OR 97701-6337 | 2008-07-02 |
| 1700081742 | Richard I. Ecker | Dermatology | 706 Ne Evans St, Mcminnville, OR 97128-3926 | 2007-06-19 |
| 1396845814 | Parwathi Vasudeva Paniker | Dermatology | 3600 N Interstate Ave, Portland, OR 97227-1106 | 2006-09-24 |
| 1184643249 | William J Delgado | Dermatology | 2705 Ne Conners Ave, Bend, OR 97701-6904 | 2006-07-19 |
| 1205805405 | Stephen N Snow | Dermatology | 3600 N Interstate Ave, Dermatology/mohs Surg Central Interstate Medical Office, Portland, OR 97227-1106 | 2006-03-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.