Basic Information
| Provider Information | |||||||||
| NPI: | 1245205475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | TAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4030 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928344030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149924444 | ||||||||
| FaxNumber: | 7148799999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N TUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149533515 | ||||||||
| FaxNumber: | 7149534529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A91924 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.