Provider Demographics
NPI:1538184973
Name:TAN, CONNIE T (MD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:T
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:251
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4101
Mailing Address - Country:US
Mailing Address - Phone:650-988-7688
Mailing Address - Fax:650-988-7638
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:251
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7688
Practice Address - Fax:650-988-7638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG00063487207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00063487OtherSTATE LICENSE NUMBER
CA00G634870Medicare ID - Type Unspecified
E97647Medicare UPIN