MEDICARE: KARING PEDIATRICS MEDICAL GROUP

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	208000000X	Pediatrics Physician	A45182	CA

General Provider Information

NPI Number	:	1053681544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARING PEDIATRICS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1025 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3402
Country	:	US
Telephone Number	:	562-491-9292
Fax Number	:	562-495-1878

Provider Business Practice Location Address
First Line	:	6628 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1715
Country	:	US
Telephone Number	:	562-531-3160
Fax Number	:	562-531-3365

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SONG TAN
Credential	:	M.D.
Telephone Number	:	562-491-9292

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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