Provider Demographics
NPI:1023282605
Name:TERESITA E. TAN, M.D. INC
Entity type:Organization
Organization Name:TERESITA E. TAN, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-382-1770
Mailing Address - Street 1:244 S OXFORD AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5126
Mailing Address - Country:US
Mailing Address - Phone:213-382-1770
Mailing Address - Fax:213-382-1895
Practice Address - Street 1:244 S OXFORD AVE STE 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5126
Practice Address - Country:US
Practice Address - Phone:213-382-1770
Practice Address - Fax:213-382-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40376261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403760Medicaid
CA1396835633OtherINDIVIDUAL NPI
CA00A403760Medicaid