Kevin Brandon Tan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

63870 Issued in CA

Practice address

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

Phone

(858) 674-6161

NPI assigned

Sep 9, 2014

Last updated

Aug 17, 2023By the provider in NPPES

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)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kevin Tan DDS Inc

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1285329680
  NPD Authorized official
• Lance Rygg Professional Dental Corporation

  dba Mission Valley Dentists

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1366701096
  NPD (past)
• Watanabe Rocksprings Dental Group, PC

  dba Rockspring Dental Corporation

  • General Practice Dentistry
  • Las Vegas, NV
  • NPI 1508906504
  NPD (past)

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1821499856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11665 AVENA PL STE 105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282427",
            "telephone_number": "858-674-6161"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "KEVIN",
        "middle_name": "BRANDON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-09",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "6525",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jingyi Tan, O.D.
• Justin Hong-Jie Tan, M.D.
• Katelin Tan
• Katherine Co Tan, DMD
• Kenneth Tan Tan, M.D.
• Kingsley Tan, PA-C
• Lea Justine Tan
• Maricel Tan
• Matthew Hien Tan, MD
• Nathaniel Tan, LVN

• 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.