MEDICARE: HUNG-JUI TAN M.D.

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	208800000X	Urology Physician	A123731	CA
2	390200000X	Student in an Organized Health Care Education/Training Program	4301090540	MI
3	208800000X	Urology Physician	201601278	NC

General Provider Information

NPI Number	:	1851597587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNG-JUI TAN M.D.

Provider Business Mailing Address
First Line	:	13075 PACIFIC PROMENADE
Second Line	:	APT 409
City	:	LOS ANGELES
State	:	CA
Zip	:	90094-2110
Country	:	US
Telephone Number	:	734-972-6075
Fax Number	:

Provider Business Practice Location Address
First Line	:	13075 PACIFIC PROMENADE
Second Line	:	APT 409
City	:	LOS ANGELES
State	:	CA
Zip	:	90094-2110
Country	:	US
Telephone Number	:	734-972-6075
Fax Number	:

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	04/01/2021

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