Healthcare Provider Details

I. General information

NPI: 1922297845
Provider Name (Legal Business Name): JOSHUA C.H. TAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST STE 608
HONOLULU HI
96813-2496
US

IV. Provider business mailing address

550 S BERETANIA ST STE 608
HONOLULU HI
96813-2496
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-8988
  • Fax: 808-538-1920
Mailing address:
  • Phone: 808-949-8988
  • Fax: 808-538-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7552
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: