Provider Demographics
NPI:1578522462
Name:TAN, DORIS TIU (DO)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:TIU
Last Name:TAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 E BRANDON LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4473
Mailing Address - Country:US
Mailing Address - Phone:559-246-2661
Mailing Address - Fax:559-455-4743
Practice Address - Street 1:2550 W CLINTON AVE
Practice Address - Street 2:BUILDING A SUITE 116
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4201
Practice Address - Country:US
Practice Address - Phone:559-264-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS112102084P0800X
CA20A79282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003193700Medicaid
FLEV877ZMedicare PIN