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General NPI Number Information
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NPI Number | 1548344625
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Entity Type | Organization
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Legal Business Name | BENITA B TAN MD INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/12/2007
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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 PLACE
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City | UNION CITY
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State | CA
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Zip | 94587
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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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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENITA B TAN
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Credential | MD
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Telephone | 510-266-0077
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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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