Lo Fu Tan, MD
Individual provider Active NPI Family Medicine Physician · San Ysidro, CA
NPI 1356314835 · NPPES record last updated Apr 25, 2024
Key facts
- NPI
- 1356314835
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- C170935 (CA)
- Practice address
- 3364 Beyer Blvd Ste 102
San Ysidro, CA 92173-1322 - Phone
- (702) 617-1227
- Fax
- (702) 492-1589
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NV, 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 |
|---|---|---|---|---|
| I20040510000913 | NV | Practitioner - Family Practice | 9830188309 | Reassigns benefits to 2 organizations |
| I20240510003094 | CA | Practitioner - Family Practice | 9830188309 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C170935 | CA | MD | Family Medicine Physician |
| 10849 | NV | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Current |
Accepting new patients | |
| Optum Medical Group Rhodes P C | Current | Accepting new patients | |
| Southwest Medical Associates, Inc | Current |
Accepting new patients | |
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Current | Accepting new patients | |
| Optum Medical Group II Rhodes P C | Current |
Accepting new patients | |
| Centro de Salud de la Comunidad de San Ysidro Inc | Current |
Accepting new patients | |
| Applegate Family Practice Clinic LLC | Family Medicine | Past | Accepting new patients |
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Past | Accepting new patients | |
| Linda L. Johnson MD, LTD | Past | Accepting new patients | |
| Lander Valley Physician Practices, LLC | Past | Accepting new patients |
Locations
1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780
1136 D Ave
National City, CA 91950
Phone (619) 336-2300
286 Euclid Ave
Ste 302
San Diego, CA 92114
Phone (619) 527-7330
3364 Beyer Blvd
Ste 102
San Ysidro, CA 92173
Phone (702) 617-1227
1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585
3364 Beyer Blvd
Ste 102103
San Ysidro, CA 92173
Phone (619) 205-4585
2845 Siena Heights Dr
Henderson, NV 89052
Phone (702) 617-1227
300 E Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 435-4301
420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710
2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C170935 | CA | Yes |
| Family Medicine Physician | 207Q00000X | 10849 | NV |
Addresses
Primary practice location
3364 Beyer Blvd Ste 102
San Ysidro, CA 92173-1322
Mailing address
1601 Precision Park LN
San Diego, CA 92173-1345
Phone (702) 617-1227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356314835 | Medicaid | NV | |
| 100502942 | Medicaid | NV |
Other providers in San Ysidro, CA
- Aurelia Stephens
- Jayson Wayne Paul Stilwell
- Elissa Kim Sullivan
- Ramon Sy
- Gregory A Talavera
- Elizabeth Tec
- Francisco Javier Tejeda
- Celeste Carina Torres
- Jennifer N Torres
- Nha Thi Tran
All providers in San Ysidro, CA · Family Medicine 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 Apr 25, 2024. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.