Individual provider Active NPI

Tieng Meng Tan, O.D.

  • Optometrist
  • San Gabriel, CA
National Provider Identifier
1467561084
Registry record updated Feb 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13131 Issued in CA
Practice address
220 W Valley Blvd
202
San Gabriel, CA 91776-3738
Phone
(626) 827-9078
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13131 CA Primary

Addresses

Primary practice location

220 W Valley Blvd
202
San Gabriel, CA 91776-3738

Mailing address

5531 E Stearns St Ste a
Long Beach, CA 90815-3125
Phone (626) 827-9078

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070319000228 CA Practitioner - Optometry 0042313736

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13131CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bunthay Chorn OD Inc Optometrist CurrentSince Oct 25, 2013 Accepting new patients

Locations

5531 E Stearns St
#A
Long Beach, CA 90815
Phone (562) 596-3838

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1467561084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5531 E STEARNS ST STE A",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153125",
            "telephone_number": "626-827-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W VALLEY BLVD",
            "address_2": "202",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763738",
            "telephone_number": "626-827-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "TIENG",
        "middle_name": "MENG",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Gabriel, CA

Sources for this page

Verify at the official NPI Registry.