Active NPI
Sam Tun Tan, D.M.D.
- Dentist
- Represa, CA
National Provider Identifier
1194921072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 47570
- Practice address
- 100 Prison Rd
Represa, CA 95671-3000 - Phone
- (916) 985-8610
- NPI assigned
- Jun 26, 2007
- Last updated
- Jun 15, 2026
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 47570 | CA | Primary |
Addresses
Primary practice location
100 Prison Rd
Represa, CA 95671-3000
Mailing address
100 Prison Rd
Represa, CA 95671-3000
Phone (916) 985-8610
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 |
|---|---|---|---|
| 47570 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1194921072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 PRISON RD",
"city": "REPRESA",
"state": "CA",
"postal_code": "956713000",
"telephone_number": "916-985-8610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PRISON RD",
"city": "REPRESA",
"state": "CA",
"postal_code": "956713000",
"telephone_number": "916-985-8610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "SAM",
"middle_name": "TUN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-26",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "47570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Represa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.