Healthcare Provider Details

I. General information

NPI: 1992640288
Provider Name (Legal Business Name): NOAH TAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PEONY CT
OAKLEY CA
94561-1872
US

IV. Provider business mailing address

74 PEONY CT
OAKLEY CA
94561-1872
US

V. Phone/Fax

Practice location:
  • Phone: 925-301-7685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: