Provider Demographics
NPI:1851597587
Name:TAN, HUNG-JUI (MD)
Entity Type:Individual
Prefix:
First Name:HUNG-JUI
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13075 PACIFIC PROMENADE
Mailing Address - Street 2:APT 409
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2110
Mailing Address - Country:US
Mailing Address - Phone:734-972-6075
Mailing Address - Fax:
Practice Address - Street 1:13075 PACIFIC PROMENADE
Practice Address - Street 2:APT 409
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90094-2110
Practice Address - Country:US
Practice Address - Phone:734-972-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123731208800000X
MI4301090540390200000X
NC201601278208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program