Individual
KENNETH TAN TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5820 OBERLIN DR, STE. 205, SAN DIEGO, CA 92121-3742
(877) 570-8362
(877) 570-8362
Mailing address
3455 S NOGALES ST, STE 140, WEST COVINA, CA 91792-5104
(626) 861-3131
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J6262
TX
2085R0202X
Diagnostic Radiology Physician
M-2019
GU
Other
Enumeration date
06/26/2008
Last updated
12/16/2020
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