Provider Demographics
NPI:1144228909
Name:TAN, PETER XUEPENG (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:XUEPENG
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 1:612 W DUARTE RD STE 505
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7627
Mailing Address - Country:US
Mailing Address - Phone:626-294-9978
Mailing Address - Fax:626-294-9526
Practice Address - Street 1:612 W DUARTE RD STE 505
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7627
Practice Address - Country:US
Practice Address - Phone:626-294-9978
Practice Address - Fax:626-294-9526
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691340Medicaid
CAH18656Medicare UPIN
CA00A691340Medicaid