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General NPI Number Information
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NPI Number | 1053681544
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Entity Type | Organization
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Legal Business Name | KARING PEDIATRICS MEDICAL GROUP
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 6628 CHERRY AVE
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City | LONG BEACH
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State | CA
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Zip | 90805-1715
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Country | US
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Telephone | 562-531-3160
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Fax | 562-531-3365
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Provider Business Mailing Address
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Address Line | 1025 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-3402
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Country | US
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Telephone | 562-491-9292
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Fax | 562-495-1878
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SONG TAN
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Credential | M.D.
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Telephone | 562-491-9292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A45182
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License Number State | CA
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