MEDICARE: EAN HUI 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	133V00000X	Registered Dietitian	871295	IL

General Provider Information

NPI Number	:	1811367345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EAN HUI TAN

Provider Business Mailing Address
First Line	:	2010 BATSON AVE APT 250
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3518
Country	:	US
Telephone Number	:	562-388-5347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 BATSON AVE APT 250
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3518
Country	:	US
Telephone Number	:	562-388-5347
Fax Number	:

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

Provider Enumeration Date	:	09/26/2015
Last Update Date	:	09/26/2015

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