Provider Demographics
NPI:1538102355
Name:TAN, JIREN (MD)
Entity Type:Individual
Prefix:MR
First Name:JIREN
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 1:5530 BIRDCAGE ST
Mailing Address - Street 2:STE 145
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:916-851-2884
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69133207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691330OtherBS OF CA
CA00A691330Medicaid
CA00A691331Medicare PIN
CA00A691330Medicaid
A37436Medicare UPIN
CAEA748ZMedicare PIN