Provider Demographics
NPI:1962465955
Name:TAN, ALFRED EUAIK (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:EUAIK
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11030 BOLLINGER CANYON RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4874
Mailing Address - Country:US
Mailing Address - Phone:925-736-2200
Mailing Address - Fax:925-736-6100
Practice Address - Street 1:11030 BOLLINGER CANYON RD
Practice Address - Street 2:SUITE240
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4874
Practice Address - Country:US
Practice Address - Phone:925-736-2200
Practice Address - Fax:925-736-6100
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG48933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51213Medicare UPIN