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General NPI Number Information
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NPI Number | 1306967609
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Entity Type | Individual
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Provider Name | BENITA B TAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 19682 HESPERIAN BLVD SUITE 202
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City | HAYWARD
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State | CA
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Zip | 94541-4752
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Country | US
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Telephone | 510-266-0077
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Fax | 510-266-0016
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Provider Business Mailing Address
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Address Line | 2806 MONTAIR PL
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City | UNION CITY
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State | CA
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Zip | 94587-1680
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Country | US
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Telephone | 510-487-2909
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Fax | 510-477-6767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A53599
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License Number State | CA
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