NPIMap

Individual provider Active NPI

Song N Tan, M.D.

  • Pediatrics Physician
  • Long Beach, CA
National Provider Identifier
1902903685
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A45182 Issued in CA
Practice address
936 Pine Ave
Long Beach, CA 90813-4326
Phone
(562) 491-9292
Fax
(562) 495-1878
NPI assigned
Sep 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A45182 CA Primary

Addresses

Primary practice location

936 Pine Ave
Long Beach, CA 90813-4326

Mailing address

936 Pine Ave
Long Beach, CA 90813-4326
Phone (562) 269-5658

Other practice location 1

1025 Atlantic Ave
Long Beach, CA 90813-3402
Phone (562) 491-9292

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)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Karing Pediatrics Medical Group Pediatrics Current Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Dignity Health Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
CHLB, LLC Past Accepting new patients

Locations

1025 Atlantic Ave
Long Beach, CA 90813
Phone (562) 491-9292

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1902903685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 PINE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908134326",
            "telephone_number": "562-269-5658",
            "fax_number": "562-495-1878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 PINE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908134326",
            "telephone_number": "562-491-9292",
            "fax_number": "562-495-1878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908133402",
            "country_code": "US",
            "telephone_number": "562-491-9292",
            "fax_number": "562-495-1878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "SONG",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A45182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.