Khek-Teck Tan, M.D.
Individual provider Active NPI General Practice Physician · Los Angeles, CA
NPI 1083753602 · NPPES record last updated Mar 19, 2008
Key facts
- NPI
- 1083753602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- A62270 (CA)
- Practice address
- 8320 Lincoln Blvd Ste 103a
Los Angeles, CA 90045-2465 - Phone
- (310) 645-2455
- Fax
- (310) 439-1136
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Tulane University School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
8320 Lincoln Blvd
103A
Los Angeles, CA 90045-2465
Hospital & facility affiliations
- 24/7 Home Health Services
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070402000736 | CA | Practitioner - General Practice | 6800990771 | Practice locations: Los Angeles, CA |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62270 | CA | MD | Dental Assistant |
| A62270 | CA | MD | General Practice Physician |
Practice roles (2 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orange Coast Memorial Medical Center | Past | Accepting new patients | |
| Playa Medical Clinic | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | A62270 | CA | Yes |
Addresses
Primary practice location
8320 Lincoln Blvd Ste 103a
Los Angeles, CA 90045-2465
Mailing address
8320 Lincoln Blvd Ste 103a
Los Angeles, CA 90045-2465
Phone (310) 645-2455
Other providers in Los Angeles, CA
- Jeffrey Andreas Tan
- Jeffrey Jing Tan
- John Muguang Tan
- Katie Le Tan
- Kevin Christopher Tan
- Leah Tan
- Lily Tan
- Lisa Tan
- Lisa Duong Tan
- Maebel Tan
All providers in Los Angeles, CA · General Practice Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.