Healthcare Provider Details

I. General information

NPI: 1285737692
Provider Name (Legal Business Name): HO TSUAN TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CLAY ST
SAN FRANCISCO CA
94108-1520
US

IV. Provider business mailing address

919 CLAY ST
SAN FRANCISCO CA
94108-1520
US

V. Phone/Fax

Practice location:
  • Phone: 415-781-8881
  • Fax: 415-781-5118
Mailing address:
  • Phone: 415-781-8881
  • Fax: 415-781-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA32071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: