Provider Demographics
NPI:1942412085
Name:WINNIE TAN, D.D.S.
Entity Type:Organization
Organization Name:WINNIE TAN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-268-9386
Mailing Address - Street 1:2621 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-3505
Mailing Address - Country:US
Mailing Address - Phone:323-268-9386
Mailing Address - Fax:323-268-9524
Practice Address - Street 1:2621 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3505
Practice Address - Country:US
Practice Address - Phone:323-268-9386
Practice Address - Fax:323-268-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental