NPIMap

Individual provider Active NPI

Maybel Min Tan, M.D

  • Nephrology Physician
  • Montebello, CA
National Provider Identifier
1053657684
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A126350 Issued in CA
Practice address
3114 W Beverly Blvd
Montebello, CA 90640-2217
Phone
(323) 726-3868
NPI assigned
Dec 31, 2012
Last updated
Aug 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A126350 CA Primary

Addresses

Primary practice location

3114 W Beverly Blvd
Montebello, CA 90640-2217

Mailing address

2149 E Warner Rd
Ste 102
Tempe, AZ 85284-3495
Phone (480) 393-0309

Other practice location 1

9808 Venice Blvd Ph
Culver City, CA 90232-2732
Phone (310) 733-4171

Other identifiers 1

IdentifierTypeStateIssuer
1053657684MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150804006089 CA Practitioner - NephrologyPractitioner - Internal Medicine 3072827062 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
L a County Nephrology Associates a Medical CorporationGroup PAC ID 3173566536, 11 clinicians

Practice addresses (Care Compare)

3114 W Beverly Blvd
Montebello, CA 90640-2217
Phone (323) 726-3868

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
99.73
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A126350CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
L a County Nephrology Associates a Medical Corporation CurrentSince May 23, 2024 Accepting new patients
Pagiel Shechter MD. Inc Nephrology CurrentSince Aug 15, 2015 Accepting new patients
Pih Health Whittier Hospital Past Accepting new patients
Alta Los Angeles Hospital, Inc Past Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
White Memorial Medical Center Past Accepting new patients
Northeast Hospital Corporation Past Accepting new patients
Eladh, LP Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Ahmc Monterey Park Hospital LP Past Accepting new patients
CHHP Holdings II, LLC Past Accepting new patients
Ahmc Greater El Monte Comm Hosp LLC Past Accepting new patients

Locations

9808 Venice Blvd
Ph
Culver City, CA 90232
Phone (310) 733-4171

7900 Pacific Blvd
Huntington Park, CA 90255
Phone (323) 277-9455

1720 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 260-5781

6222 Wilshire Blvd
Ste 304
Los Angeles, CA 90048
Phone (310) 507-7100

309 W Beverly Blvd
Montebello, CA 90640
Phone (323) 725-4209

3114 W Beverly Blvd
Montebello, CA 90640
Phone (323) 726-1317

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: maybel.tan.1@16656.direct.athenahealth.com

Organizations & group practices 13

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

View all 13

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1053657684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD",
            "address_2": "STE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843495",
            "telephone_number": "480-393-0309",
            "fax_number": "480-610-6189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3114 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906402217",
            "telephone_number": "323-726-3868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9808 Venice Blvd Ph",
            "address_purpose": "LOCATION",
            "city": "Culver City",
            "state": "CA",
            "postal_code": "902322732",
            "country_code": "US",
            "telephone_number": "310-733-4171",
            "fax_number": "310-559-0996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "MAYBEL",
        "middle_name": "MIN",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-31",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A126350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053657684",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

Verify at the official NPI Registry.