Provider Demographics
NPI:1932166238
Name:JOSHUA CH TAN MD INC
Entity Type:Organization
Organization Name:JOSHUA CH TAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:CH
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-949-8988
Mailing Address - Street 1:550 S BERETANIA ST
Mailing Address - Street 2:STE # 608
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2496
Mailing Address - Country:US
Mailing Address - Phone:808-949-8988
Mailing Address - Fax:808-538-1920
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:STE # 608
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2414
Practice Address - Country:US
Practice Address - Phone:808-949-8988
Practice Address - Fax:808-538-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GW054AOtherPTAN
HI07096001Medicaid
F71649Medicare UPIN