Healthcare Provider Details

I. General information

NPI: 1821230467
Provider Name (Legal Business Name): LAREN DAO-WEI TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST # MC-1516
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST ROOM 6427
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4908
  • Fax:
Mailing address:
  • Phone: 909-558-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113182
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA113182
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA113182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: