Provider Demographics
NPI:1285329680
Name:KEVIN TAN DDS INC
Entity type:Organization
Organization Name:KEVIN TAN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-633-2303
Mailing Address - Street 1:7823 STYLUS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2620
Mailing Address - Country:US
Mailing Address - Phone:909-633-2303
Mailing Address - Fax:
Practice Address - Street 1:11665 AVENA PL STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2427
Practice Address - Country:US
Practice Address - Phone:858-674-6161
Practice Address - Fax:858-674-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty