Healthcare Provider Details

I. General information

NPI: 1235362500
Provider Name (Legal Business Name): IVY TAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 POST ST
SAN FRANCISCO CA
94109-5603
US

IV. Provider business mailing address

8 CARDENAS AVE
SAN FRANCISCO CA
94132-2416
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 415-205-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: