Kondrad R Tan, MOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

181014 Issued in NV

Practice address

4855 Blue Diamond Rd Ste 210
Las Vegas, NV 89139-7602

Phone

(725) 207-3770

Fax

(702) 505-9020

NPI assigned

Aug 6, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1750860284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6575 W TROPICANA AVE APT 1067",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891034741",
            "telephone_number": "818-280-7468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 BLUE DIAMOND RD STE 210",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891397602",
            "telephone_number": "725-207-3770",
            "fax_number": "702-505-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "KONDRAD",
        "middle_name": "R",
        "credential": "MOT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-06",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NV",
            "license": "181014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith L. Tan, APRN
• Jullie Tan
• Karissa Tan, APN-BC
• Keisha Mae Tan
• Kevin Tan, DDS
• Kylie Nicole Tan, BSN, RN
• Leopoldo Castillo Tan Jr., APRN-CNP
• Maria Eunice D Tan, NP
• Mark Tan, MD
• Medina Tan, FNP-BC

• Occupational Therapist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Occupational Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.