Provider Demographics
NPI:1861578569
Name:TAN, SOON MIN (MD)
Entity type:Individual
Prefix:DR
First Name:SOON MIN
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7231
Mailing Address - Country:US
Mailing Address - Phone:626-357-6808
Mailing Address - Fax:626-357-6290
Practice Address - Street 1:488 E SANTA CLARA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7231
Practice Address - Country:US
Practice Address - Phone:626-357-6808
Practice Address - Fax:626-357-6290
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA66493207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
660003933OtherMEDICARE RAILROAD
CAOOA664930OtherBLUE SHIELD
CAOOA664930Medicaid
CAOOA664930OtherBLUE SHIELD
CAOOA664930Medicaid