Provider Demographics
NPI:1902903685
Name:TAN, SONG N (MD)
Entity Type:Individual
Prefix:DR
First Name:SONG
Middle Name:N
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4326
Mailing Address - Country:US
Mailing Address - Phone:562-269-5658
Mailing Address - Fax:562-495-1878
Practice Address - Street 1:936 PINE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4326
Practice Address - Country:US
Practice Address - Phone:562-491-9292
Practice Address - Fax:562-495-1878
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2037222Medicare UPIN