Provider Demographics
NPI:1891715033
Name:TAN, STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-825-8707
Mailing Address - Fax:
Practice Address - Street 1:1000 VETERAN AVE A641
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2022
Practice Address - Country:US
Practice Address - Phone:310-825-8173
Practice Address - Fax:310-794-8837
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679120OtherMEDICAL PPIN #
CAWA67912CMedicare ID - Type UnspecifiedPPIN #
CA00A679120OtherMEDICAL PPIN #
CAWA67912AMedicare ID - Type UnspecifiedPPIN #