Provider Demographics
NPI:1982766382
Name:TAN, TERENCE TZ (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:TZ
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THANT
Other - Middle Name:
Other - Last Name:ZIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3301 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3301
Mailing Address - Country:US
Mailing Address - Phone:310-638-5188
Mailing Address - Fax:310-637-0278
Practice Address - Street 1:3301 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3301
Practice Address - Country:US
Practice Address - Phone:310-638-5188
Practice Address - Fax:310-637-0278
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47880208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478800Medicaid
A47880Medicare ID - Type Unspecified
F36690Medicare UPIN