Provider Demographics
NPI:1891227369
Name:TAN, JUN
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 FOREST PARK RD
Mailing Address - Street 2:BL11.202D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9315
Mailing Address - Country:US
Mailing Address - Phone:214-648-5058
Mailing Address - Fax:
Practice Address - Street 1:6363 FOREST PARK RD
Practice Address - Street 2:BL11.202D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9315
Practice Address - Country:US
Practice Address - Phone:214-648-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program