Provider Demographics
NPI:1659752319
Name:KEVIN TAN, MD, AND PRODUCTIONS, INC
Entity Type:Organization
Organization Name:KEVIN TAN, MD, AND PRODUCTIONS, INC
Other - Org Name:EYECARE ASSOCIATES OF SAN FRANCISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAIRI
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-982-2020
Mailing Address - Street 1:360 POST ST STE 1005
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4913
Mailing Address - Country:US
Mailing Address - Phone:415-982-2020
Mailing Address - Fax:415-982-2011
Practice Address - Street 1:360 POST ST STE 1005
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4913
Practice Address - Country:US
Practice Address - Phone:415-982-2020
Practice Address - Fax:415-982-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063654978Medicaid