Healthcare Provider Details

I. General information

NPI: 1992622344
Provider Name (Legal Business Name): MICHAEL TAN RN,NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 UPLAND AVE
FONTANA CA
92335-3535
US

IV. Provider business mailing address

8285 WHEELER AVE
FONTANA CA
92335-3538
US

V. Phone/Fax

Practice location:
  • Phone: 626-905-5957
  • Fax:
Mailing address:
  • Phone: 626-905-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: