Provider Demographics
NPI:1881720092
Name:TAN, KHEE H (MD)
Entity type:Individual
Prefix:DR
First Name:KHEE
Middle Name:H
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1436 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3656
Mailing Address - Country:US
Mailing Address - Phone:626-554-1028
Mailing Address - Fax:626-280-4389
Practice Address - Street 1:1436 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3656
Practice Address - Country:US
Practice Address - Phone:626-280-7055
Practice Address - Fax:626-280-4389
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A392360Medicaid
CAA28845Medicare UPIN
CA00A392360Medicaid