Provider Demographics
NPI:1427373323
Name:TAN, ECHO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ECHO
Middle Name:E
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S. SAN VICENTE BLVD.
Mailing Address - Street 2:SUITE A6600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-423-6472
Mailing Address - Fax:310-423-0148
Practice Address - Street 1:127 S. SAN VICENTE BLVD.
Practice Address - Street 2:SUITE A6600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-6472
Practice Address - Fax:310-423-0148
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1187762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program