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NPI Code Detail

MEDICARE: JERRY TAN

MEDICARE: JERRY 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
1237700000XHearing Instrument Specialist3142CA

General Provider Information

NPI Number : 1780171785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY TAN
Provider Business Mailing Address
First Line : 3500 E COLORADO BLVD STE 108
Second Line :
City : PASADENA
State : CA
Zip : 91107-3832
Country : US
Telephone Number : 626-585-8883
Fax Number :
Provider Business Practice Location Address
First Line : 3500 E COLORADO BLVD STE 108
Second Line :
City : PASADENA
State : CA
Zip : 91107-3832
Country : US
Telephone Number : 626-585-8883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2018
Last Update Date : 04/16/2018

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Directions to “ JERRY TAN ” Practice Location

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