Provider Demographics
NPI:1316561871
Name:TAN, HENDRIK RYAN LUMAKANG (DPM)
Entity type:Individual
Prefix:
First Name:HENDRIK RYAN
Middle Name:LUMAKANG
Last Name:TAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2905
Mailing Address - Country:US
Mailing Address - Phone:707-544-3337
Mailing Address - Fax:707-544-0608
Practice Address - Street 1:2281 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2905
Practice Address - Country:US
Practice Address - Phone:707-544-3337
Practice Address - Fax:707-544-0608
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001406A213ES0103X
COPDT.0000593390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery