Basic Information
| Provider Information | |||||||||
| NPI: | 1215394036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KC TAN, M.D. MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 W DUARTE RD UNIT G-865 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910077564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262820296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W HUNTINGTON DR | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910073402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262835680 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2016 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | TAN | ||||||||
| AuthorizedOfficialFirstName: | KOK CHYE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6268613131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A120081 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | A120081 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085N0700X | A120081 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.