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Individual

MR. BENJO TAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
520 N MAIN ST STE 220, SANTA ANA, CA 92701-4623
(714) 543-5609
Mailing address
382 N LEMON AVE # 401, WALNUT, CA 91789-2344
(949) 394-7094

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95017880
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95017880
NURSE PRACTITIONER LICENSE
CA
Enumeration date
08/17/2021
Last updated
09/12/2022
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