Healthcare Provider Details

I. General information

NPI: 1265216832
Provider Name (Legal Business Name): JAN KEVIN TAN MAGPANTAY MSN, APRN, AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

5020 TORRANCE BLVD
TORRANCE CA
90503-4116
US

V. Phone/Fax

Practice location:
  • Phone: 323-398-9731
  • Fax:
Mailing address:
  • Phone: 323-398-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026172
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95026172
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95026172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: