Healthcare Provider Details

I. General information

NPI: 1447646377
Provider Name (Legal Business Name): KEVIN TZAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 TAUB LOOP
HOUSTON TX
77030-1608
US

IV. Provider business mailing address

1504 TAUB LOOP
HOUSTON TX
77030-1608
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-2860
  • Fax:
Mailing address:
  • Phone: 713-873-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR7344
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: