Individual
JACQUELINE TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2211 MOORPARK AVE STE 130, SAN JOSE, CA 95128-2655
(408) 286-1707
Mailing address
2211 MOORPARK AVE STE 130, SAN JOSE, CA 95128-2655
(408) 286-1707
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
64013
CA
Other
Enumeration date
09/12/2022
Last updated
09/26/2024
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