Healthcare Provider Details

I. General information

NPI: 1568985471
Provider Name (Legal Business Name): KEVIN TAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N HARRISON ST
PRINCETON NJ
08540-3521
US

IV. Provider business mailing address

619 ALEXANDER RD STE 203
PRINCETON NJ
08540-6017
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-3345
  • Fax: 609-683-8847
Mailing address:
  • Phone: 732-821-5563
  • Fax: 732-821-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00736900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26NR15551400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: