Healthcare Provider Details

I. General information

NPI: 1376214395
Provider Name (Legal Business Name): TAMMY MIN TAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19153 COLIMA RD
ROWLAND HEIGHTS CA
91748-3003
US

IV. Provider business mailing address

19153 COLIMA RD
ROWLAND HEIGHTS CA
91748-3003
US

V. Phone/Fax

Practice location:
  • Phone: 626-655-8228
  • Fax:
Mailing address:
  • Phone: 626-655-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: