Individual provider Active NPI

Khea Marie Tan

  • Transplant Surgery Physician
  • Atlanta, GA
National Provider Identifier
1255960860
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Transplant Surgery PhysicianTaxonomy code 204F00000X
License
102988 Issued in GA
Practice address
101 Woodruff Circle WMB Suite 51505
Atlanta, GA 30322-4859
Phone
(855) 366-7989
NPI assigned
Apr 6, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Transplant Surgery Physician 204F00000X 102988 GA Primary

Addresses

Primary practice location

101 Woodruff Circle WMB Suite 51505
Atlanta, GA 30322-4859

Mailing address

5 Anderson CT
Sayreville, NJ 08872-1000

Other practice location 1

1945 State Route 33
Neptune, NJ 07753-4859
Phone (732) 775-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250729000159 GA Practitioner - General Surgery 0749797488 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Temple University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
102988GAMDTransplant Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Egleston Pediatric Group Current Accepting new patients
The Emory Clinic Inc Transplant Surgery CurrentSince Jul 5, 2025 Accepting new patients
Choa Hospital Based, LLC CurrentSince Aug 5, 2025 Accepting new patients
Choa Multispecialty, LLC Current Accepting new patients
Emory Health Care Past Accepting new patients

Locations

1364 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 712-7100

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

1405 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 785-1112

1365 Clifton Rd NE
Ste B6400
Atlanta, GA 30322
Phone (404) 778-5770

2220 N Druid Hills Rd NE
Brookhaven, GA 30329
Phone (404) 778-1440

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1255960860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ANDERSON CT",
            "city": "SAYREVILLE",
            "state": "NJ",
            "postal_code": "088721000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WOODRUFF CIRCLE WMB SUITE 51505",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303224859",
            "telephone_number": "855-366-7989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1945 State Route 33",
            "address_purpose": "LOCATION",
            "city": "Neptune",
            "state": "NJ",
            "postal_code": "077534859",
            "country_code": "US",
            "telephone_number": "732-775-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "KHEA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "GA",
            "license": "102988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.