Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A167215 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A167215 | CA |
NPI | 1023404910 |
---|---|
Provider Name | Timothy Lang Tan |
First Address | Pleasanton, CA 94588-8215 |
Second Address | Visalia, CA 93277-7287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 16/08/2021 |