Provider Demographics
NPI:1285812495
Name:TAN, JASON ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 S BERETANIA ST
Mailing Address - Street 2:SUITE 201-202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1149
Mailing Address - Country:US
Mailing Address - Phone:646-801-9771
Mailing Address - Fax:
Practice Address - Street 1:1575 S BERETANIA ST
Practice Address - Street 2:SUITE 201-202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1149
Practice Address - Country:US
Practice Address - Phone:646-801-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93699207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology