Provider Demographics
NPI:1861690299
Name:TAN, BELINDA H (MD)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:H
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 DEL AMO BLVD
Mailing Address - Street 2:UNIT 507
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2165
Mailing Address - Country:US
Mailing Address - Phone:310-222-6510
Mailing Address - Fax:310-222-1847
Practice Address - Street 1:3870 DEL AMO BLVD
Practice Address - Street 2:UNIT 507
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2165
Practice Address - Country:US
Practice Address - Phone:310-222-6510
Practice Address - Fax:310-222-1847
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA100913207ND0900X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology