Active NPI
Adam G Clark-Tan, LCSW
- Clinical Social Worker
- Daly City, CA
National Provider Identifier
1093024937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 63563
- Practice address
- 21 Penhurst Ave
Daly City, CA 94015-4423 - Phone
- (415) 763-7782
- NPI assigned
- Sep 27, 2010
- 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 Social Worker | 1041C0700X | 63563 | CA | Primary |
Addresses
Primary practice location
21 Penhurst Ave
Daly City, CA 94015-4423
Mailing address
21 Penhurst Ave
Daly City, CA 94015-4423
Phone (415) 763-7782
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63563 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477872000000",
"number": "1093024937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 PENHURST AVE",
"city": "DALY CITY",
"state": "CA",
"postal_code": "940154423",
"telephone_number": "415-763-7782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 PENHURST AVE",
"city": "DALY CITY",
"state": "CA",
"postal_code": "940154423",
"telephone_number": "415-763-7782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK-TAN",
"first_name": "ADAM",
"middle_name": "G",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-27",
"last_updated": "2016-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "63563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daly City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.