Kevin Tan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7778 Issued in NV

Practice address

4205 S Grand Canyon Dr Ste 19
Las Vegas, NV 89147-7152

Phone

(702) 805-1117

NPI assigned

Jul 16, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Kevin Tan DDS LLC

  • General Practice Dentistry
  • Las Vegas, NV
  • NPI 1962389106
  NPD Authorized official
• Jarrod C. Cornehl, DDS, PC

  • General Practice Dentistry
  • San Francisco, CA
  • NPI 1043589096
  NPD

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1356913487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 S GRAND CANYON DR STE 19",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891477152",
            "telephone_number": "702-805-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 S GRAND CANYON DR STE 19",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891477152",
            "telephone_number": "702-805-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-16",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "7778",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106598",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Tan, APRN
• Judith L. Tan, APRN
• Jullie Tan
• Karissa Tan, APN-BC
• Keisha Mae Tan
• Kondrad R Tan, MOT
• Kylie Nicole Tan, BSN, RN
• Leopoldo Castillo Tan Jr., APRN-CNP
• Maria Eunice D Tan, NP
• Mark Tan, MD

• Dentist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; 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.