Provider Demographics
NPI:1770159949
Name:TAN, JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5399 CEDARBRIDGE WAY
Mailing Address - Street 2:APT. 621
Mailing Address - City:RICHMOND
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V6X0L6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2110 DECARIE BLVD
Practice Address - Street 2:
Practice Address - City:MONTREAL
Practice Address - State:QUEBEC
Practice Address - Zip Code:H4A 3J3
Practice Address - Country:CA
Practice Address - Phone:514-369-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD472529207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty