MEDICARE: CHRIS TAN

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1366997694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS TAN

Provider Business Mailing Address
First Line	:	2951 E VIKING RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4156
Country	:	US
Telephone Number	:	702-471-7204
Fax Number	:

Provider Business Practice Location Address
First Line	:	2951 E VIKING RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4156
Country	:	US
Telephone Number	:	702-471-7204
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/16/2016

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Directions to “ CHRIS TAN ” Practice Location

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