Individual
DR. MARK TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
209 FAIR OAKS AVE, SOUTH PASADENA, CA 91030-1814
(626) 396-2900
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
(626) 775-3514
(626) 218-5310
Taxonomy
Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
A94624
CA
208200000X
Plastic Surgery Physician
A94624
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A946240
—
CA
Enumeration date
10/04/2006
Last updated
11/13/2020
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