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General NPI Number Information
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NPI Number | 1497895007
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Entity Type | Individual
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Provider Name | BRUCE KUANG-HUAY TAN M.D
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 675 N SAINT CLAIR ST SUITE 15-200
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City | CHICAGO
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State | IL
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Zip | 60611-5975
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Country | US
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Telephone | 312-695-3222
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Fax | 312-695-3194
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Provider Business Mailing Address
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Address Line | 420 E OHIO ST #28B
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City | CHICAGO
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State | IL
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Zip | 60611-3390
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Country | US
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Telephone | 202-256-2985
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036.122820
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License Number State | IL
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