Provider Demographics
NPI:1114089497
Name:TAN, THOMAS HIE-LAR (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HIE-LAR
Last Name:TAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-370 PUPUPANI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2657
Mailing Address - Country:US
Mailing Address - Phone:808-676-7700
Mailing Address - Fax:808-676-7708
Practice Address - Street 1:94-370 PUPUPANI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2657
Practice Address - Country:US
Practice Address - Phone:808-676-7700
Practice Address - Fax:808-676-7708
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52464Medicare ID - Type Unspecified