Individual provider Active NPI

Tara Tanaka, M.D.

  • Pediatrics Physician
  • Burlingame, CA
National Provider Identifier
1003913690
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A74834 Issued in CA
Practice address
1720 El Camino Real Ste 205
Burlingame, CA 94010-3226
Phone
(650) 259-5050
NPI assigned
Sep 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A74834 CA Primary

Addresses

Primary practice location

1720 El Camino Real Ste 205
Burlingame, CA 94010-3226

Mailing address

1720 El Camino Real Ste 205
Burlingame, CA 94010-3226
Phone (650) 259-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121128000205 CA Practitioner - Pediatric Medicine 9638321524 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
LPCH Medical Group Div of Lucile Pediatrics CurrentSince Oct 9, 2012 Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Mills-Peninsula Health Services Past Accepting new patients

Locations

1720 El Camino Real
Ste 205
Burlingame, CA 94010
Phone (650) 259-5050

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003913690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 EL CAMINO REAL STE 205",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103226",
            "telephone_number": "650-259-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 EL CAMINO REAL STE 205",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103226",
            "telephone_number": "650-259-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANAKA",
        "first_name": "TARA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A74834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlingame, CA

Sources for this page

Verify at the official NPI Registry.