Healthcare Provider Details

I. General information

NPI: 1275386757
Provider Name (Legal Business Name): KENNETH TZAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 210
PHILADELPHIA PA
19107-4405
US

IV. Provider business mailing address

833 CHESTNUT ST STE 210
PHILADELPHIA PA
19107-4405
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8420
  • Fax: 215-503-0429
Mailing address:
  • Phone: 215-955-5638
  • Fax: 215-503-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: