Provider Demographics
NPI:1760419204
Name:TAN, MICHAEL P (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:TAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE #128
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2408
Mailing Address - Country:US
Mailing Address - Phone:626-308-3981
Mailing Address - Fax:626-308-7422
Practice Address - Street 1:1200 S ATLANTIC BLVD
Practice Address - Street 2:SUITE #128
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2408
Practice Address - Country:US
Practice Address - Phone:626-308-3981
Practice Address - Fax:626-308-7422
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20-A-68752084N0400X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX68750OtherMEDICAL
CA00AX68750OtherMEDICAL