Provider Demographics
NPI:1083753602
Name:TAN, KHEK-TECK (MD)
Entity Type:Individual
Prefix:DR
First Name:KHEK-TECK
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 LINCOLN BLVD STE 103A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2465
Mailing Address - Country:US
Mailing Address - Phone:310-645-2455
Mailing Address - Fax:310-439-1136
Practice Address - Street 1:8320 LINCOLN BLVD STE 103A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2465
Practice Address - Country:US
Practice Address - Phone:310-645-2455
Practice Address - Fax:310-439-1136
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62270208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62270AMedicare ID - Type Unspecified
CAG49435Medicare UPIN