MEDICARE: SHUFANG TAN DMD

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	1223G0001X	General Practice Dentistry	DN27044	FL
2	1223G0001X	General Practice Dentistry	DDS108707	CA

General Provider Information

NPI Number	:	1528793858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUFANG TAN DMD

Provider Business Mailing Address
First Line	:	15850 SOQUEL CANYON PKWY STE A
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5874
Country	:	US
Telephone Number	:	909-375-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	15850 SOQUEL CANYON PKWY STE A
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5874
Country	:	US
Telephone Number	:	909-375-0133
Fax Number	:

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

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	05/24/2023

Similar Medicare Providers

1376216002 — DR. TALEEN JUDY DAVIDIAN DDS
Practice Location Address:

15850 SOQUEL CANYON PKWY STE A
CHINO HILLS, CA
91709-5874

Practice Phone: 909-375-0133
Practice Fax:

1891413274 — POUYA ANSARI DMD
Practice Location Address:

15850 SOQUEL CANYON PKWY STE A
CHINO HILLS, CA
91709-5874

Practice Phone: 909-375-0133
Practice Fax:

1578536553 — JAMES W CONNOR MD
Practice Location Address:

27331 HIDDEN TRAIL RD
LAGUNA HILLS, CA
92653-5874

Practice Phone: 949-643-1150
Practice Fax: 716-246-0346

1265666903 — ANGEL HEARTS INC.
Practice Location Address:

17037 CHATSWORTH ST STE 206
GRANADA HILLS, CA
91344-5874

Practice Phone: 818-217-4666
Practice Fax:

1225352016 — MOHAMMAD JAMIL WAQAR RPH
Practice Location Address:

11 ALLEY POND CT
DIX HILLS, NY
11746-5874

Practice Phone: 516-353-8984
Practice Fax: 631-367-1266

1194361006 — MARCOS DANIEL JASSO MA LEVEL
Practice Location Address:

17037 CHATSWORTH ST STE 206
GRANADA HILLS, CA
91344-5874

Practice Phone: 818-937-0882
Practice Fax: 818-937-0883

Directions to “ SHUFANG TAN DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.