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General NPI Number Information
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NPI Number | 1396408266
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Entity Type | Individual
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Provider Name | YUAN PENG TAN
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Gender | Male
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 9353 VALLEY BLVD STE C
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City | ROSEMEAD
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State | CA
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Zip | 91770-1923
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Country | US
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Telephone | 626-287-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 2834 BLOSSOM CT
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City | EL MONTE
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State | CA
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Zip | 91733-2402
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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 | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | PT42079
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License Number State | CA
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