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General NPI Number Information
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NPI Number | 1215394036
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Entity Type | Organization
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Legal Business Name | KC TAN, M.D. MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 525 N GARFIELD AVE
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City | MONTEREY PARK
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State | CA
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Zip | 91754-1202
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Country | US
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Telephone | 626-522-6030
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Fax | 626-782-7462
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Provider Business Mailing Address
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Address Line | 713 W DUARTE RD UNIT G-781
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City | ARCADIA
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State | CA
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Zip | 91007-7564
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Country | US
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Telephone | 626-282-0296
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KOK CHYE TAN
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Credential | M.D.
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Telephone | 626-861-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A120081
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A120081
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A120081
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License Number State | CA
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