Provider Demographics
NPI:1699896357
Name:RAYMOND C. TAN, MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RAYMOND C. TAN, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-386-6000
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94042-1360
Mailing Address - Country:US
Mailing Address - Phone:209-386-6000
Mailing Address - Fax:650-618-0465
Practice Address - Street 1:3850 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8787
Practice Address - Country:US
Practice Address - Phone:209-386-6000
Practice Address - Fax:209-386-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA732522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732520Medicaid
CA00A732520Medicare ID - Type Unspecified
CAIO7662Medicare UPIN