Westlane Medical Clinic,Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A325500 Issued in CA

Legal business name

WESTLANE MEDICAL CLINIC,INC

Practice address

4873 West LN
Suite a
Stockton, CA 95210-4548

Phone

(209) 472-1515

Fax

(209) 472-1651

NPI assigned

Jan 24, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gabriel Kodzo Tanson, M.D.NPI 1023053105

Title

Medical Director

Phone

(209) 472-1515

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gabriel Kodzo Tanson, M.D.,

  • Family Medicine Physician
  • Stockton, CA
  • NPI 1023053105
  Medicare reassignment Care Compare group NPD Authorized official
• Elvis Akpene Tanson, D.O.

  • Family Medicine Physician
  • Stockton, CA
  • NPI 1720136138
  Medicare reassignment Care Compare group NPD
• Piseth Suor, PA

  • Physician Assistant
  • Stockton, CA
  • NPI 1699054809
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1689729352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4873 WEST LN",
            "address_2": "SUITE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952104548",
            "telephone_number": "209-472-1515",
            "fax_number": "209-472-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4873 WEST LN",
            "address_2": "SUITE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952104548",
            "telephone_number": "209-472-1515",
            "fax_number": "209-472-1651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTLANE MEDICAL CLINIC,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "TANSON",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "KODZO",
        "authorized_official_title_or_position": "MEDICAL  DIRECTOR",
        "authorized_official_telephone_number": "209-472-1515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A325500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A325500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Western Dental Services, Inc.
• Western Dental Services, Inc.
• Western Dental Services, Inc.
• Western Dental Services, Inc.
• George W Westin Jr., MD
• Joanne Weston, FNP
• Nathan Weston
• Christie Lynn Westover, M.S. CCC-SLP
• Sabrina Wettstein
• Keith Weyuker, MFTI

• Family Medicine Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.