MEDICARE: DR. LORENA H TAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A61352	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417957697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORENA H TAN MD

Provider Business Mailing Address
First Line	:	1133 E STANLEY BLVD
Second Line	:	SUITE 201
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4200
Country	:	US
Telephone Number	:	925-443-9000
Fax Number	:	925-443-9009

Provider Business Practice Location Address
First Line	:	1133 E STANLEY BLVD
Second Line	:	SUITE 201
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4200
Country	:	US
Telephone Number	:	925-443-9000
Fax Number	:	925-443-9009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	11/15/2016

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