Kim Gepana Tan, P.T.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

070.019410 Issued in IL

Practice address

5241 Jog LN
Delray Beach, FL 33484-6652

Phone

(561) 496-7993

NPI assigned

Feb 5, 2014

Last updated

Feb 5, 2014By the provider in NPPES

Sex

Male

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

Enrolled in FL

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1871972653
  Medicare reassignment NPD
• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Independence, MO
  • NPI 1871072462
  NPD

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1982028478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5241 JOG LANE",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "33484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5241 JOG LN",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334846652",
            "telephone_number": "561-496-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "KIM",
        "middle_name": "GEPANA",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-05",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "IL",
            "license": "070.019410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Tenaya Talley, PA-C
• Alejandro Y Tamayo, DPT
• Kristin Ape Tambongco
• Tampa General Provider Network Inc
• Lovelle Palomeno Tampoco, PT
• Janique Tang How
• Tania Koolik, PHD, PA
• Kari Tannenbaum, M.D.
• Ernesto Tano, MD
• Mirjana Tasic-Pantic, RPH, CPH

• Community Health Worker in Delray Beach, FL
• Providers in Delray Beach, FL by specialty
• Community Health Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.