Provider Demographics
NPI:1689737983
Name:TAN, JOE W (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:W
Last Name:TAN
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:40000 FREMONT BLVD
Mailing Address - Street 2:#E
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-683-0633
Mailing Address - Fax:925-251-0097
Practice Address - Street 1:40000 FREMONT BLVD
Practice Address - Street 2:#E
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-683-0633
Practice Address - Fax:925-251-0097
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC1573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist