Healthcare Provider Details

I. General information

NPI: 1932166238
Provider Name (Legal Business Name): JOSHUA CH TAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST STE # 608
HONOLULU HI
96813-2414
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: JOSHUA CH TAN
Title or Position: PRESIDENT OF THE CORPORATION
Credential: MD
Phone: 808-949-8988