Healthcare Provider Details

I. General information

NPI: 1417156811
Provider Name (Legal Business Name): JESSICA CHI-MIN TAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 06/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE L-371
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

625 RHODE ISLAND ST APT 2
SAN FRANCISCO CA
94107-2643
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1668
  • Fax:
Mailing address:
  • Phone: 415-866-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA103757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: