Mark K Tanabe, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY29456 Issued in CA

Practice address

595 E Colorado Blvd Ste 628
Pasadena, CA 91101-5222

Phone

(626) 278-2301

NPI assigned

Nov 9, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1982958153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23913 RANNEY HOUSE CT",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913553336",
            "telephone_number": "626-278-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 E COLORADO BLVD STE 628",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911015222",
            "telephone_number": "626-278-2301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 Schrader Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900286213",
            "country_code": "US",
            "telephone_number": "323-993-7669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANABE",
        "first_name": "MARK",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-09",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Tan, M.A., CCC-SLP
• Patrick Edward Tan
• Renee Tan
• Shay Ting Daphne Tan, PT, DPT
• Suzil Lynchi Jurilla Tan, RN
• Charlene Desulo Tancinco
• Megan Tancredi, RD
• Arvin Taneja, MD
• Lynda Tanekeu
• George Tang, M.D.

• Clinical Psychologist in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.