Provider Demographics
NPI:1194751750
Name:JEFFREY TAN HO, INC.
Entity type:Organization
Organization Name:JEFFREY TAN HO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-894-6600
Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:BUILDING G-1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4607
Mailing Address - Country:US
Mailing Address - Phone:714-434-8663
Mailing Address - Fax:714-549-9287
Practice Address - Street 1:9191 WESTMINSTER AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2751
Practice Address - Country:US
Practice Address - Phone:714-894-6600
Practice Address - Fax:714-583-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8218208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI36129Medicare UPIN
CAW20300Medicare PIN