Tetris Ylizah Apostol Tan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A209622 Issued in CA

Practice address

17089 Main St
Hesperia, CA 92345-6075

Phone

(760) 956-4123

NPI assigned

Jul 25, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1104506005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10554 CANNON DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17089 MAIN ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456075",
            "telephone_number": "760-956-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "TETRIS YLIZAH",
        "middle_name": "APOSTOL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-25",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A209622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desiree Sundeen
• Sung M. Ahn, D.D.S., Inc.
• Stephen John Svastits, D.C.,C.C.S.P.,I.D.E.
• Makinzie Sweet
• Andrew Tadang, PHARMD
• Sophia Tannenberg
• Suehong Tao, MD
• Amy Tapia
• Naomi Tapia
• Joseph Louis Tate, P.A.C.

• Internal Medicine Physician in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.