MEDICARE: LO FU TAN MD

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	C170935	CA
2	207Q00000X	Family Medicine Physician	10849	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356314835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LO FU TAN MD

Provider Business Mailing Address
First Line	:	1601 PRECISION PARK LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92173-1345
Country	:	US
Telephone Number	:	702-617-1227
Fax Number	:	702-492-1589

Provider Business Practice Location Address
First Line	:	3364 BEYER BLVD STE 102
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-1322
Country	:	US
Telephone Number	:	702-617-1227
Fax Number	:	702-492-1589

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	04/25/2024

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Directions to “ LO FU TAN MD” Practice Location

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