MEDICARE: MONY CHAN TAN NP

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
1	363LF0000X	Family Nurse Practitioner	F07230717	CA

General Provider Information

NPI Number	:	1538943113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONY CHAN TAN NP

Provider Business Mailing Address
First Line	:	1360 E ANAHEIM ST STE 1031360E
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5514
Country	:	US
Telephone Number	:	562-270-0324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 E ANAHEIM ST STE 101-103
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5514
Country	:	US
Telephone Number	:	562-270-0324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/05/2025

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