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NPI Code Detail

MEDICARE: DR. HENRY HINCHUNG TAN MD

MEDICARE: DR. HENRY HINCHUNG TAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianD58871MD
2207RC0200XCritical Care Medicine (Internal Medicine) Physician240004NY
3207RP1001XPulmonary Disease Physician240004NY
4207RC0200XCritical Care Medicine (Internal Medicine) PhysicianA111285CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366447369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENRY HINCHUNG TAN MD
Provider Business Mailing Address
First Line : 2450 ASHBY AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2067
Country : US
Telephone Number : 510-204-1894
Fax Number :
Provider Business Practice Location Address
First Line : 2450 ASHBY AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2067
Country : US
Telephone Number : 510-204-1894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 12/22/2021

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