MEDICARE: JESUS KING 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	207Y00000X	Otolaryngology Physician	A31335	CA

General Provider Information

NPI Number	:	1730185687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS KING TAN MD

Provider Business Mailing Address
First Line	:	2865 ATLANTIC AVE
Second Line	:	STE 225
City	:	LONG BEACH
State	:	CA
Zip	:	90806-7428
Country	:	US
Telephone Number	:	562-988-8818
Fax Number	:	562-988-8819

Provider Business Practice Location Address
First Line	:	2865 ATLANTIC AVE
Second Line	:	STE 225
City	:	LONG BEACH
State	:	CA
Zip	:	90806-7428
Country	:	US
Telephone Number	:	562-988-8818
Fax Number	:	562-988-8819

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/28/2010

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