Provider Demographics
NPI:1356314835
Name:TAN, LO FU (MD)
Entity type:Individual
Prefix:
First Name:LO FU
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 PRECISION PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1345
Mailing Address - Country:US
Mailing Address - Phone:702-617-1227
Mailing Address - Fax:702-492-1589
Practice Address - Street 1:3364 BEYER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1322
Practice Address - Country:US
Practice Address - Phone:702-617-1227
Practice Address - Fax:702-492-1589
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC170935207Q00000X
NV10849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356314835Medicaid
NV100502942Medicaid
NV38823Medicare PIN
NV0673440002Medicare NSC
NV100502942Medicaid
G22971Medicare UPIN