Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Michael Tannenbaum, PA

Individual provider Physician Assistant · NPI 1457553885

Michael Tannenbaum, PA is a Physician Assistant in Modesto, California. Qualified in 2006, 20 years ago. Practices with Kaiser Foundation Health Plan of the Northwest, a 1,811-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
20
Licensed in
OR
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1808 Scenic Dr Apt 107
Modesto, CA 95355
Phone: (510) 409-8966
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA01230 (OR)

Record details

NPI number1457553885
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 5, 2007
Last updated in NPPESJune 12, 2009
Mailing address1808 Scenic Dr, Apt 107, Modesto, CA 95355-4947

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Kaiser Foundation Health Plan Of The Northwest — 1811 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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