Provider Demographics
NPI:1194959825
Name:TAT, SAN (MD MPH)
Entity type:Individual
Prefix:DR
First Name:SAN
Middle Name:
Last Name:TAT
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:DR
Other - First Name:SONNY
Other - Middle Name:
Other - Last Name:TAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MPH
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS M691
Mailing Address - Street 2:505 PARNASSUS AVE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-5001
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PEDIATRICS M691
Practice Address - Street 2:505 PARNASSUS AVE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-476-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN