Healthcare Provider Details

I. General information

NPI: 1063654978
Provider Name (Legal Business Name): KEVIN TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 BUCKINGHAM WAY STE 448
SAN FRANCISCO CA
94132-1912
US

IV. Provider business mailing address

595 BUCKINGHAM WAY STE 448
SAN FRANCISCO CA
94132-1912
US

V. Phone/Fax

Practice location:
  • Phone: 415-982-2020
  • Fax: 415-982-2011
Mailing address:
  • Phone: 415-982-2020
  • Fax: 415-982-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA114778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: