Provider Demographics
NPI:1538943113
Name:TAN, MONY CHAN (NP)
Entity type:Individual
Prefix:
First Name:MONY
Middle Name:CHAN
Last Name:TAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E ANAHEIM ST STE 1031360E
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5514
Mailing Address - Country:US
Mailing Address - Phone:562-270-0324
Mailing Address - Fax:
Practice Address - Street 1:1360 E ANAHEIM ST STE 101-103
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5514
Practice Address - Country:US
Practice Address - Phone:562-270-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF07230717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily