Individual
CHRISTOPHER TAN VANICHSARN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1955 CITRACADO PKWY STE 300, ESCONDIDO, CA 92029-4113
(760) 743-0546
(858) 673-5187
Mailing address
10790 RANCHO BERNARDO RD, SAN DIEGO, CA 92127-5705
(858) 554-9100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A129210
CA
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
A129210
CA
207RC0000X
Cardiovascular Disease Physician
A129210
CA
208M00000X
Hospitalist Physician
A129210
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A129210
CA MEDICAL LICENSE
CA
Enumeration date
04/12/2012
Last updated
11/30/2020
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