Provider Demographics
NPI:1043868847
Name:TAN, JEAN CHENG YEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN CHENG YEE
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 W OREGON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4511
Mailing Address - Country:US
Mailing Address - Phone:267-616-9832
Mailing Address - Fax:
Practice Address - Street 1:1620 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4511
Practice Address - Country:US
Practice Address - Phone:267-616-9832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0422301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice