Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | A70063 | CA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | A70063 | CA |
NPI | 1093807679 |
---|---|
Provider Name | Vivian R. Tan |
First Address | Baldwin Park, CA 91706-5806 |
Second Address | Baldwin Park, CA 91706-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 19/10/2010 |