MEDICARE: DR. MARIA LILIBETH TAN SY M.D.

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	208000000X	Pediatrics Physician	A52234	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A52234	OTHER	CA	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1700897741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA LILIBETH TAN SY M.D.

Provider Business Mailing Address
First Line	:	425 NOREN ST
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-2756
Country	:	US
Telephone Number	:	818-787-5800
Fax Number	:	818-787-5810

Provider Business Practice Location Address
First Line	:	8162 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4806
Country	:	US
Telephone Number	:	818-787-5800
Fax Number	:	818-787-5810

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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