Organization
PRO SPORTS INSTITUTE A MEDICAL CORPORATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK TAN DEE MD (PRESIDENT)
(310) 408-5345
Entity
Organization
Contact information
Practice address
7677 CENTER AVE, SUITE 403, HUNTINGTON BEACH, CA 92647-3074
(714) 379-9355
(714) 379-5402
Mailing address
7677 CENTER AVE, SUITE 403, HUNTINGTON BEACH, CA 92647-3074
(714) 379-9355
(714) 379-5402
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
23165
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
65423
CA
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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