Mintra Tan, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

53108 Issued in CA

Practice address

151 S Mednik Ave
East Los Angeles, CA 90022-1606

Phone

(323) 263-3303

NPI assigned

Oct 1, 2008

Last updated

Oct 1, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Tan, DDS and Tran, DDS, Inc

  • Pediatric Dentistry
  • Los Angeles, CA
  • NPI 1407191810
  NPD (past) Authorized official
• Michelle to, DDS Inc

  dba Children's Dental Fun Land

  • Pediatric Dentistry
  • East Los Angeles, CA
  • NPI 1972528958
  NPD (past)

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1821249426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 S MEDNIK AVE",
            "city": "EAST LOS ANGELES",
            "state": "CA",
            "postal_code": "900221606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 S MEDNIK AVE",
            "city": "EAST LOS ANGELES",
            "state": "CA",
            "postal_code": "900221606",
            "telephone_number": "323-263-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "MINTRA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "53108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Sandoval
• Estella Sneider, PH.D.
• Soul Practice Licensed Clinical Social Worker PC (Soul Practice Group)
• Spectera
• Dabrina L Suttle
• Keilyn Tanimoto, DPT
• Cindy Joana Tapia-Mendoza
• Valeria Del Rocio Temblador
• Dao Tien Truong
• Gisela Valenzuela

• Pediatric Dentistry in East Los Angeles, CA
• Providers in East Los Angeles, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.