Provider Demographics
NPI:1609338029
Name:TAN, KEVIN TZAY-JYH (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:TZAY-JYH
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 1:333 CITY BLVD W STE 2150
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5920
Mailing Address - Country:US
Mailing Address - Phone:714-456-6661
Mailing Address - Fax:714-456-7702
Practice Address - Street 1:333 CITY BLVD W STE 2150
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5920
Practice Address - Country:US
Practice Address - Phone:714-456-6661
Practice Address - Fax:714-456-7702
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177253207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology