Provider Demographics
NPI:1891424370
Name:TAN, LUHONG (PA-C)
Entity type:Individual
Prefix:
First Name:LUHONG
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3401 AERO JET AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2801
Mailing Address - Country:US
Mailing Address - Phone:626-286-8700
Mailing Address - Fax:626-286-8650
Practice Address - Street 1:1661 HANOVER RD STE 103
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-5705
Practice Address - Country:US
Practice Address - Phone:626-286-8700
Practice Address - Fax:626-286-8650
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-2300363A00000X
CA63915363A00000X
1191213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant