Healthcare Provider Details

I. General information

NPI: 1467953927
Provider Name (Legal Business Name): LINDA MAW TAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2472-2 WHIPPLE ROAD 215
HAYWARD CA
94544-7806
US

IV. Provider business mailing address

2472-2 WHIPPLE ROAD 215
HAYWARD CA
94544-7806
US

V. Phone/Fax

Practice location:
  • Phone: 510-386-3912
  • Fax:
Mailing address:
  • Phone: 510-386-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: