Provider Demographics
NPI:1609013739
Name:TANN, MELVIN SWEE SAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:SWEE SAM
Last Name:TANN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34135 MOONGATE CT
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2671
Mailing Address - Country:US
Mailing Address - Phone:949-373-6336
Mailing Address - Fax:
Practice Address - Street 1:34135 MOONGATE CT
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2671
Practice Address - Country:US
Practice Address - Phone:949-373-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12531171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist