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General NPI Number Information
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NPI Number | 1023385101
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Entity Type | Organization
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Legal Business Name | RANDALL HEALTHCARE INC
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 350 30TH ST #100
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City | OAKLAND
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State | CA
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Zip | 94609-3424
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Country | US
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Telephone | 510-342-2239
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Fax | 510-380-7143
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Provider Business Mailing Address
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Address Line | 360 GRAND AVE #332
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City | OAKLAND
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State | CA
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Zip | 94610-4840
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Country | US
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Telephone | 510-342-2239
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Fax | 510-380-7143
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Authorized Official
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Title or Position | MD
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Name | DR. RANDALL LEROY TAN
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Credential | MD
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Telephone | 510-342-2239
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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 | G62879
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License Number State | CA
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