Provider Demographics
NPI:1710235783
Name:TAN, SYDNEY (PSYD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 SACRAMENTO ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1723
Mailing Address - Country:US
Mailing Address - Phone:415-767-5229
Mailing Address - Fax:
Practice Address - Street 1:3637 SACRAMENTO ST
Practice Address - Street 2:SUITE F
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1723
Practice Address - Country:US
Practice Address - Phone:415-767-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-24
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical