1750500591 NPI number — TZE-WOEI TAN M.D.

Table of content: TZE-WOEI TAN M.D. (NPI 1750500591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750500591 NPI number — TZE-WOEI TAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAN
Provider First Name:
TZE-WOEI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750500591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N CAMPBELL AVE RM 4402
Provider Second Line Business Mailing Address:
PO BOX 245072
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85724-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-626-6670
Provider Business Mailing Address Fax Number:
520-626-4008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N CAMPBELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85724-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-626-6670
Provider Business Practice Location Address Fax Number:
520-626-4008
Provider Enumeration Date:
04/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  205219 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 205219 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 52469 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2194356 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4Q988F600 . This is a "MEDICARE - PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".