Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A126350 | CA |
NPI | 1053657684 |
---|---|
Provider Name | Maybel Min Tan |
First Address | Tempe, AZ 85284-3495 |
Second Address | Montebello, CA 90640-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2012 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053657684 | (05) | CA |