Provider Demographics
NPI:1912902602
Name:TAN, CHRISTOPHER ADI (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ADI
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 1:3080 BRISTOL ST
Mailing Address - Street 2:STE 600
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7341
Mailing Address - Country:US
Mailing Address - Phone:714-445-0220
Mailing Address - Fax:714-445-0245
Practice Address - Street 1:790 E WILLOW ST STE 150
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2719
Practice Address - Country:US
Practice Address - Phone:714-445-0220
Practice Address - Fax:714-445-0246
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA705092080P0202X
GUM-16182080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology