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General NPI Number Information
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NPI Number | 1023404910
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Entity Type | Individual
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Provider Name | TIMOTHY LANG TAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 2300 W SUNNYSIDE AVE
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City | VISALIA
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State | CA
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Zip | 93277-7287
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Country | US
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Telephone | 559-731-2009
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Fax | 866-833-7251
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Provider Business Mailing Address
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Address Line | 1946 CLOVER CT
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City | PLEASANTON
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State | CA
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Zip | 94588-8215
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Country | US
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Telephone |
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Fax |
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | A167215
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A167215
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License Number State | CA
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