MEDICARE: DR. JIAYIN TAN DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	36593	TX
2	1223G0001X	General Practice Dentistry	36593	TX

General Provider Information

NPI Number	:	1295332591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIAYIN TAN DDS, MS

Provider Business Mailing Address
First Line	:	10080 BELLAIRE BLVD STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10080 BELLAIRE BLVD STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5429
Country	:	US
Telephone Number	:	281-575-0742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	09/10/2025

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