Regina Mallari Tan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

41314 Issued in CA

Practice address

30 Centerpointe Drive
Suite 10
La Palma, CA 90623

Phone

(714) 994-0888

Fax

(714) 994-6038

NPI assigned

Jan 10, 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

Other names 1

• Maria Regina Mallari Tan Former name

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

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.

• Regina Tan DDS Inc.

  • Dentist
  • La Palma, CA
  • NPI 1346635265
  NPD (past) Authorized official
• Licauco Tan Dental Corp

  • Dentist
  • La Palma, CA
  • NPI 1952431033
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1972653491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CENTERPOINTE DRIVE",
            "address_2": "SUITE 10",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "90623",
            "telephone_number": "714-994-0888",
            "fax_number": "714-994-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CENTERPOINTE DRIVE",
            "address_2": "SUITE 10",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "90623",
            "telephone_number": "714-994-0888",
            "fax_number": "714-994-6038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "REGINA",
        "middle_name": "MALLARI",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA REGINA",
            "last_name": "TAN",
            "middle_name": "MALLARI",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Su Yong Pak,M.D. Inc
• Nathan Suaste
• Emily Summers
• Peter Justin Garcia Taguinod, DPT
• Kwan Toh Tan, M.D.
• Jennifer S Tanaka, P.T.
• Tanz Wu, M.D., Inc
• Christina Danielle Tapia, J.D.
• Taylor T. Pham DDS a Professional Corp.
• Telecare Corporation

• Dentist in La Palma, CA
• Providers in La Palma, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.