Healthcare Provider Details

I. General information

NPI: 1215394036
Provider Name (Legal Business Name): KC TAN, M.D. MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N GARFIELD AVE
MONTEREY PARK CA
91754-1202
US

IV. Provider business mailing address

713 W DUARTE RD UNIT G-781
ARCADIA CA
91007-7564
US

V. Phone/Fax

Practice location:
  • Phone: 626-522-6030
  • Fax: 626-782-7462
Mailing address:
  • Phone: 626-282-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA120081
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA120081
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA120081
License Number StateCA

VIII. Authorized Official

Name: DR. KOK CHYE TAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-861-3131