Kevin Tan DDS Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KEVIN TAN DDS INC

Practice address

11665 Avena PL Ste 105
San Diego, CA 92128-2427

Phone

(858) 674-6161

Fax

(858) 674-6162

NPI assigned

Apr 11, 2023

Organization subpart

No

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

Authorized official

Name

Kevin Brandon Tan, DDSNPI 1821499856

Title

Dentist

Phone

(909) 633-2303

Specialties & licenses 1

Addresses

Other names 1

• Kevin Tan DDS Inc Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Brandon Tan, DDS

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1821499856
  NPD Authorized official

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1285329680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7823 STYLUS DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082620",
            "telephone_number": "909-633-2303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11665 AVENA PL STE 105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282427",
            "telephone_number": "858-674-6161",
            "fax_number": "858-674-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN TAN DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-11",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "909-633-2303",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kevin Tan DDS Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kevin Tan DDS Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Darneil Eugene Key
• Andrew Robert Keyes, M.D.
• Kara Alana Keyes, CRNA

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.