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General NPI Number Information
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NPI Number | 1013099746
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Entity Type | Individual
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Provider Name | KWAN TOH TAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 7872 WALKER ST
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City | LA PALMA
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State | CA
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Zip | 90623-1796
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Country | US
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Telephone | 714-527-8777
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Fax | 714-527-8990
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Provider Business Mailing Address
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Address Line | 13561 YORBA ST
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City | SANTA ANA
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State | CA
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Zip | 92705-1869
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Country | US
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Telephone | 714-527-8943
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Fax | 714-527-9086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G74232
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License Number State | CA
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