Healthcare Provider Details

I. General information

NPI: 1104335702
Provider Name (Legal Business Name): ESTHER HANYU TAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANYU TAN

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date: 06/11/2021
Reactivation Date: 08/03/2021

III. Provider practice location address

74 CENTRAL ST UNIT B
WELLESLEY MA
02482-5734
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax:
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2346740
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: