Healthcare Provider Details

I. General information

NPI: 1164614699
Provider Name (Legal Business Name): FRANK M. TAN MD & JULIA K. LAM MD, A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 SAWTELLE BLVD SUITE 1
LOS ANGELES CA
90025-5532
US

IV. Provider business mailing address

1823 SAWTELLE BLVD SUITE 1
LOS ANGELES CA
90025-5532
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 Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG31393
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG31393
License Number StateCA

VIII. Authorized Official

Name: DR. FRANK MARDEN TAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 310-826-3180