KENNETH TAN (MD) – Family Medicine Physician, NPI 1013918283
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for KENNETH TAN (MD)
Saint Jude Heritage Medical Group, 4300, Rose Drive, Yorba Linda, Orange County, California, 92886, United States
YORBA LINDA, CA 928862026
Phone: (714) 528-4211
Fax: (714) 579-6868
Type: Location
279 IMPERIAL HWY
SUITE 730
FULLERTON, CA 928351041
Phone: (714) 449-4841
Fax: (714) 449-4956
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $53.
Total Amount is formed as General ($53) + Research ($0) + Ownership ($0) = $53.
Last reported payment date: 2023-05-18 • Largest payer in this snapshot: Boehringer Ingelheim Pharmaceuticals, Inc. ($21).
Total Amount
$53
General + Research + Ownership
Payments
3
Total payment records
General Amount
$53
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-05-18
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-04-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100427000676 | I | Family Practice | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 104 | 84 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 97 | 77 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 65 | 57 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 43 | 43 | $0 |
Insurance plans in this area (ZIP 92886)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | CA | 90670 | Pneumococcal vaccine for injection into muscle | 23 | 23 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | CA | |
| - | CA | |
| - | WA | |
| - | ME | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA | |
| - | CA |
Reviews
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