Provider Demographics
NPI:1164614699
Name:FRANK M. TAN MD & JULIA K. LAM MD, A MEDICAL CORP.
Entity Type:Organization
Organization Name:FRANK M. TAN MD & JULIA K. LAM MD, A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:MARDEN
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-826-3180
Mailing Address - Street 1:1823 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5532
Mailing Address - Country:US
Mailing Address - Phone:310-826-3180
Mailing Address - Fax:310-454-6422
Practice Address - Street 1:1823 SAWTELLE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5532
Practice Address - Country:US
Practice Address - Phone:310-826-3180
Practice Address - Fax:310-454-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG313932084P0802X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44756Medicare UPIN
A44756Medicare PIN