Organization
FANG TAN MD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FANG TAN M.D. (CEO)
(510) 793-2800
Entity
Organization
Contact information
Practice address
1895 MOWRY AVE, SUITE 101A, FREMONT, CA 94538-1708
(510) 793-2800
(510) 793-2882
Mailing address
3232 BRUCE DR, FREMONT, CA 94539-5013
(510) 793-2800
(510) 793-2882
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A81026
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A810260
—
CA
Enumeration date
04/14/2006
Last updated
08/19/2015
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