Healthcare Provider Details

I. General information

NPI: 1518527845
Provider Name (Legal Business Name): MATTHEW HONG GIE TAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E 17TH ST STE 200
SANTA ANA CA
92705-6852
US

IV. Provider business mailing address

2601 E CHAPMAN AVE
ORANGE CA
92869-3206
US

V. Phone/Fax

Practice location:
  • Phone: 714-495-4050
  • Fax: 714-497-1485
Mailing address:
  • Phone: 714-633-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA182435
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036165387
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: