Provider Demographics
NPI:1588079123
Name:TAN, ALVIN
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:TAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 UNIVERSITY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1148
Mailing Address - Country:US
Mailing Address - Phone:650-363-4030
Mailing Address - Fax:650-328-6834
Practice Address - Street 1:2415 UNIVERSITY AVE STE 301
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1148
Practice Address - Country:US
Practice Address - Phone:650-363-4030
Practice Address - Fax:650-328-6834
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
CA943481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program