Healthcare Provider Details

I. General information

NPI: 1205874187
Provider Name (Legal Business Name): KAREN SHIH TAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN SHIH M.D.

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST EMERGENCY DEPARTMENT
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

393 E WALNUT ST MARITZA UMPIERRE
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-2013
  • Fax:
Mailing address:
  • Phone: 888-505-0043
  • Fax: 626-405-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA86299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: