Provider Demographics
NPI:1811339013
Name:TAN, ENG KEONG (MD)
Entity type:Individual
Prefix:DR
First Name:ENG KEONG
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:PO BOX 516598
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0598
Mailing Address - Country:US
Mailing Address - Phone:866-964-3795
Mailing Address - Fax:
Practice Address - Street 1:2874 N CARSON ST STE 120
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706
Practice Address - Country:US
Practice Address - Phone:775-888-6513
Practice Address - Fax:775-884-5462
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV18176207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program