Healthcare Provider Details

I. General information

NPI: 1104181734
Provider Name (Legal Business Name): TAPAN PANDYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 KATELLA AVE STE 320
LOS ALAMITOS CA
90720-3567
US

IV. Provider business mailing address

3851 KATELLA AVE STE 315
LOS ALAMITOS CA
90720-3377
US

V. Phone/Fax

Practice location:
  • Phone: 562-626-8016
  • Fax: 562-626-8017
Mailing address:
  • Phone: 562-626-8016
  • Fax: 562-626-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA155589
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA155589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: