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General NPI Number Information
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NPI Number | 1851597587
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Entity Type | Individual
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Provider Name | HUNG-JUI TAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 13075 PACIFIC PROMENADE APT 409
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City | LOS ANGELES
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State | CA
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Zip | 90094-2110
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Country | US
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Telephone | 734-972-6075
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Fax |
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Provider Business Mailing Address
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Address Line | 13075 PACIFIC PROMENADE APT 409
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City | LOS ANGELES
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State | CA
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Zip | 90094-2110
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Country | US
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Telephone | 734-972-6075
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A123731
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License Number State | CA
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Taxonomy #2
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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 | 4301090540
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 201601278
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License Number State | NC
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