Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95005097 | CA |
NPI | 1023488814 |
---|---|
Provider Name | Wanting Tan |
First Address | Los Angeles, CA 90010 |
Second Address | Los Angeles, CA 90010-3820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 08/09/2019 |