MEDICARE: DR. NATHAN CHI YONG TAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0306	MP

General Provider Information

NPI Number	:	1023079761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN CHI YONG TAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 500118
Second Line	:
City	:	SAIPAN
State	:	MP
Zip	:	96950-0118
Country	:	US
Telephone Number	:	670-235-0994
Fax Number	:	670-234-3742

Provider Business Practice Location Address
First Line	:	BEACH ROAD, OLEAI BUSINESS CENTER
Second Line	:	SUITE 108-112
City	:	SAN JOSE, SAIPAN
State	:	MP
Zip	:	96950
Country	:	US
Telephone Number	:	670-235-0994
Fax Number	:	670-234-3742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	06/08/2009

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