Healthcare Provider Details

I. General information

NPI: 1104813013
Provider Name (Legal Business Name): JASON C TANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JASON C TANI MD

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/10/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ARTESIA ST STE 360
POMONA CA
91767-2927
US

IV. Provider business mailing address

17100B BEAR VALLEY RD # 283
VICTORVILLE CA
92395-5851
US

V. Phone/Fax

Practice location:
  • Phone: 760-552-8585
  • Fax: 760-243-7276
Mailing address:
  • Phone: 760-552-8585
  • Fax: 760-243-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24700
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG160274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: