Healthcare Provider Details

I. General information

NPI: 1922942812
Provider Name (Legal Business Name): TAMMY LUAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FOURTH AVE STE 510
SAN DIEGO CA
92103-2121
US

IV. Provider business mailing address

4060 FOURTH AVE STE 510
SAN DIEGO CA
92103-2121
US

V. Phone/Fax

Practice location:
  • Phone: 619-686-4011
  • Fax:
Mailing address:
  • Phone: 408-621-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LUAN
Title or Position: OWNER
Credential: MD
Phone: 408-621-5095