Provider Demographics
NPI:1578910352
Name:TAN, DAI (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DAI
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 GLEN COTSWOLD CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2545
Mailing Address - Country:US
Mailing Address - Phone:408-858-8858
Mailing Address - Fax:
Practice Address - Street 1:1721 TECHNOLOGY DR FL 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1305
Practice Address - Country:US
Practice Address - Phone:408-436-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist