Healthcare Provider Details

I. General information

NPI: 1629149901
Provider Name (Legal Business Name): JOSEPH SON TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD #312
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

PO BOX 4929
CERRITOS CA
90703-4929
US

V. Phone/Fax

Practice location:
  • Phone: 562-404-0503
  • Fax: 562-529-8828
Mailing address:
  • Phone: 562-404-0503
  • Fax: 562-529-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA40103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: