Provider Demographics
NPI:1588823082
Name:VAN, TUAN TAN
Entity Type:Individual
Prefix:MR
First Name:TUAN
Middle Name:TAN
Last Name:VAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BAHIA LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2077
Mailing Address - Country:US
Mailing Address - Phone:760-504-2719
Mailing Address - Fax:
Practice Address - Street 1:1485 INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5303
Practice Address - Country:US
Practice Address - Phone:800-798-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 8322225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant