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General NPI Number Information
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NPI Number | 1104132422
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Entity Type | Individual
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Provider Name | JINGYI TAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 4353 LA JOLLA VILLAGE DR SUITE H20
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City | SAN DIEGO
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State | CA
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Zip | 92122-1259
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Country | US
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Telephone | 858-622-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 FELSPAR ST UNIT #33
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City | SAN DIEGO
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State | CA
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Zip | 92109-2828
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Country | US
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Telephone | 678-687-6505
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14057
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License Number State | CA
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