Healthcare Provider Details

I. General information

NPI: 1124762950
Provider Name (Legal Business Name): XIAO F TAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 39TH AVE
SAN MATEO CA
94403-4364
US

IV. Provider business mailing address

222 W 39TH AVE
SAN MATEO CA
94403-4364
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2385
  • Fax:
Mailing address:
  • Phone: 650-573-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: