Active NPI
Alexander Tan, PHD
- Clinical Neuropsychologist
- Orange, CA
National Provider Identifier
1033792882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY32493
- Practice address
- 1201 W la Veta Ave
Orange, CA 92868-4203 - Phone
- (714) 509-7379
- NPI assigned
- Apr 29, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY32493 | CA | Primary |
Addresses
Primary practice location
1201 W la Veta Ave
Orange, CA 92868-4203
Mailing address
1000 W Town and Country Rd Unit 309
Orange, CA 92868-4759
Other practice location 1
1000 W Town and Country Rd Unit 309
Orange, CA 92868-4759
Phone (714) 509-7379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY32493 | CA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1033792882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 W TOWN AND COUNTRY RD UNIT 309",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 W LA VETA AVE",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684203",
"telephone_number": "714-509-7379"
}
],
"practiceLocations": [
{
"address_1": "1000 W Town and Country Rd Unit 309",
"address_purpose": "LOCATION",
"city": "Orange",
"state": "CA",
"postal_code": "928684759",
"country_code": "US",
"telephone_number": "714-509-7379",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TAN",
"first_name": "ALEXANDER",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-29",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY32493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.