Provider Demographics
NPI:1316986045
Name:HO, JEFFREY TAN (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TAN
Last Name:HO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:BLDG G-1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-434-8663
Mailing Address - Fax:714-549-9287
Practice Address - Street 1:9191 WESTMINSTER AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2751
Practice Address - Country:US
Practice Address - Phone:714-894-6600
Practice Address - Fax:714-583-6367
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA136129208100000X
CA20A8218208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI36129Medicare UPIN
CAW20A8218BMedicare PIN