MEDICARE: JEFFREY 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	2085R0202X	Diagnostic Radiology Physician	A81541	CA

General Provider Information

NPI Number	:	1912092859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY TAN

Provider Business Mailing Address
First Line	:	2917 DAIMLER ST # US
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5810
Country	:	US
Telephone Number	:	949-428-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 DAIMLER ST # US
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5810
Country	:	US
Telephone Number	:	949-428-0500
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/31/2019

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