Winnie Tan, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

56333 Issued in CA

Practice address

2621 E 1St St
Los Angeles, CA 90033-3505

Phone

(323) 268-9386

Fax

(323) 268-9524

NPI assigned

Feb 7, 2007

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

State licenses

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.

• Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1104075282
  Medicare reassignment NPD
• Winnie Tan, D.D.S.

  • Dental Clinic/Center
  • Los Angeles, CA
  • NPI 1942412085
  NPD (past) Authorized official
• Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1013083666
  NPD
• Dr. Khakshooy & Dr. Vahedi Dental, Inc.

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1790164960
  NPD (past)

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730229832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 E 1ST ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900333505",
            "telephone_number": "323-268-9386",
            "fax_number": "323-268-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 E 1ST ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900333505",
            "telephone_number": "323-268-9386",
            "fax_number": "323-268-9524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "WINNIE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Tan, MD
• Steven Tan, MD
• Teresita Egido Tan, MD
• Tiffany Molina Tan
• Wanting Tan, PMHNP
• Winright Dominic Tan, OT
• Yi Wei Tan
• Zaldy S Tan, M.D.
• Tana Medical Supplies, Inc.
• Ryoko Tanabe, NP

• Dentist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.