Healthcare Provider Details

I. General information

NPI: 1285729723
Provider Name (Legal Business Name): FRANK M TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD. SUITE 612
LOS ANGELES CA
90049
US

IV. Provider business mailing address

11980 SAN VICENTE BLVD. SUITE 612
LOS ANGELES CA
90049
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-3180
  • Fax: 310-454-6422
Mailing address:
  • Phone: 310-826-3180
  • Fax: 310-454-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG31393
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG31393
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG31393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: