Active NPI
Edsel Tan, LAC
- Acupuncturist
- Santa Monica, CA
National Provider Identifier
1265612345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC 12003
- Practice address
- 1131 Wilshire Blvd
Suite 300
Santa Monica, CA 90401-2061 - Phone
- (310) 917-2200
- Fax
- (310) 917-2204
- NPI assigned
- Nov 6, 2007
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC 12003 | CA | Primary |
Addresses
Primary practice location
1131 Wilshire Blvd
Suite 300
Santa Monica, CA 90401-2061
Mailing address
1131 Wilshire Blvd
Suite 300
Santa Monica, CA 90401-2061
Phone (310) 917-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AC 12003 | Other | CA | LICENSE |
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 |
|---|---|---|---|
| AC 12003 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224028800000",
"number": "1265612345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1131 WILSHIRE BLVD",
"address_2": "SUITE 300",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904012061",
"telephone_number": "310-917-2200",
"fax_number": "310-917-2204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1131 WILSHIRE BLVD",
"address_2": "SUITE 300",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904012061",
"telephone_number": "310-917-2200",
"fax_number": "310-917-2204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "EDSEL",
"name_prefix": "Mr.",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-06",
"last_updated": "2008-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC 12003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "AC 12003",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.