| Peter X. Tan Medical Corporation | |
|
1990 Sierra Madre Villa Ave Pasadena CA 91107-1235 | |
| (626) 354-9113 | |
| (626) 389-5055 |
| Full Name | Peter X. Tan Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 1990 Sierra Madre Villa Ave, Pasadena, California |
| Authorized Official Name and Position | Peter X. Tan (PRESIDENT) |
| Authorized Official Contact | 6263549113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter X. Tan Medical Corporation 1990 Sierra Madre Villa Ave Pasadena CA 91107-1235 Ph: (626) 354-9113 | Peter X. Tan Medical Corporation 1990 Sierra Madre Villa Ave Pasadena CA 91107-1235 Ph: (626) 354-9113 |
| NPI Number | 1649322975 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 12/07/2017 |
| Medicare PECOS PAC ID | 2567405855 |
|---|---|
| Medicare Enrollment ID | O20050607001357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649322975 | NPI | - | NPPES |
| 00A691340 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A69134 (California) | Primary |
| Provider Name | Peter X Tan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144228909 PECOS PAC ID: 9739168782 Enrollment ID: I20040714001318 |
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