Active NPI
Michelle Nathania Tan, DO
- General Practice Physician
- Jbphh, HI
National Provider Identifier
1669237236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0102209499
- Practice address
- 480 Central Ave
Jbphh, HI 96860-4908 - Phone
- (808) 448-3285
- NPI assigned
- Feb 14, 2024
- Last updated
- Mar 16, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0102209499 | VA | Primary |
| Military Health Care Provider | 171000000X |
Addresses
Primary practice location
480 Central Ave
Jbphh, HI 96860-4908
Mailing address
III Marine Expeditionary Force Surgeon
Unit 35605
Fpo, AP 96382
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102209499 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773619200000",
"number": "1669237236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "III MARINE EXPEDITIONARY FORCE SURGEON",
"address_2": "UNIT 35605",
"city": "FPO",
"state": "AP",
"postal_code": "96382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 CENTRAL AVE",
"city": "JBPHH",
"state": "HI",
"postal_code": "968604908",
"telephone_number": "808-448-3285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "MICHELLE",
"middle_name": "NATHANIA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-14",
"last_updated": "2026-03-16",
"certification_date": "2026-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0102209499",
"primary": true
},
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbphh, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.