Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A129210 | CA |
N | 111NI0900X | Internist | A129210 | CA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | A129210 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | A129210 | CA |
NPI | 1851658173 |
---|---|
Provider Name | Christopher Tan Vanichsarn |
First Address | San Diego, CA 92127-5705 |
Second Address | Escondido, CA 92029-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A129210 | CA MEDICAL LICENSE (01) | CA |