Organization
KEN C. TAN, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN RYONO (OFFICE MANAGER)
(626) 964-6352
Entity
Organization
Contact information
Practice address
250 S GRAND AVE, GLENDORA, CA 91741-4218
(626) 857-3140
Mailing address
PO BOX 4007, DIAMOND BAR, CA 91765-0007
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
12782
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A319380
—
CA
Enumeration date
12/08/2006
Last updated
10/01/2007
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