Provider Demographics
NPI:1538699913
Name:TAN, YING MING BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:YING
Middle Name:MING BENJAMIN
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-3625
Mailing Address - Country:US
Mailing Address - Phone:530-626-2787
Mailing Address - Fax:530-626-2839
Practice Address - Street 1:1095 MARSHALL WAY STE 202
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5722
Practice Address - Country:US
Practice Address - Phone:530-626-3682
Practice Address - Fax:530-748-0325
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA159195208600000X
FLME155266208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery