Individual
DR. LUNG KANG TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
5202 FARAON ST STE A, SAINT JOSEPH, MO 64506-3840
(816) 271-1067
(816) 271-1071
Mailing address
5301 FARAON ST STE 120, SAINT JOSEPH, MO 64506-3800
(816) 271-1067
(816) 271-1071
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
2004035104
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301208005
—
MO
01
—
P00353075
RAILROAD
—
Enumeration date
06/24/2006
Last updated
10/30/2017
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