Basic Information
| Provider Information | |||||||||
| NPI: | 1710475462 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TAN | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 824 N 2ND ST APT 3 | ||||||||
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| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918011370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083682115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 W BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906404308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237261222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2018 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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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 | 363A00000X | PA55620 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.