Provider Demographics
NPI:1912907726
Name:TAN, HAU HIEN (MD)
Entity Type:Individual
Prefix:MR
First Name:HAU
Middle Name:HIEN
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 1:7871 UNIVERSITY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0471
Mailing Address - Country:US
Mailing Address - Phone:619-287-8270
Mailing Address - Fax:619-287-8272
Practice Address - Street 1:7871 UNIVERSITY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0471
Practice Address - Country:US
Practice Address - Phone:619-287-8270
Practice Address - Fax:619-287-8272
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A634280Medicaid
CAW18642Medicare ID - Type UnspecifiedMEDICARE GROUP #
CAY32347Medicare UPIN