Active NPI
Elizabeth Yap Tan, D.M.D.
- Dentist
- Newark, CA
National Provider Identifier
1891778015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 41683
- Practice address
- 5270 Newpark Mall Rd.
Newark, CA 94560 - Phone
- (510) 791-8118
- Fax
- (510) 797-8881
- NPI assigned
- Nov 22, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 41683 | CA | Primary |
Addresses
Primary practice location
5270 Newpark Mall Rd.
Newark, CA 94560
Mailing address
5270 Newpark Mall Rd
Newark, CA 94560
Phone (510) 791-8118
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151223001583 | CA | Order and Referring Only - Dentist | 8628379260 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41683 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413331200000",
"number": "1891778015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5270 NEWPARK MALL RD",
"city": "NEWARK",
"state": "CA",
"postal_code": "94560",
"telephone_number": "510-791-8118",
"fax_number": "510-797-8881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5270 NEWPARK MALL RD.",
"city": "NEWARK",
"state": "CA",
"postal_code": "94560",
"telephone_number": "510-791-8118",
"fax_number": "510-797-8881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "ELIZABETH",
"middle_name": "YAP",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-22",
"last_updated": "2014-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "41683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.