Katherine Co Tan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

104321 Issued in CA

Practice address

3774 Clairemont Dr
San Diego, CA 92117-5916

Phone

(858) 274-1219

NPI assigned

Jun 5, 2019

Sex

Female

Sole proprietor

No

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

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Katherine C Tan DMD Inc

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1366222168
  NPD Authorized official
• Marilou C. Tan, D.D.S. Professional Dental Corporation

  • General Practice Dentistry
  • Sacramento, CA
  • NPI 1700976461
  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1639737414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3774 CLAIREMONT DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921175916",
            "telephone_number": "858-274-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3774 CLAIREMONT DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921175916",
            "telephone_number": "858-274-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "KATHERINE",
        "middle_name": "CO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evangeline Tan
• Jennifer Lim Tan
• Jingyi Tan, O.D.
• Justin Hong-Jie Tan, M.D.
• Katelin Tan
• Kenneth Tan Tan, M.D.
• Kevin Brandon Tan, DDS
• Kingsley Tan, PA-C
• Lea Justine Tan
• Maricel Tan

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.