Provider Demographics
NPI:1164144549
Name:TAN, ALICE HYUN-KYUNG (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:HYUN-KYUNG
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 SE 65TH PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8668
Mailing Address - Country:US
Mailing Address - Phone:425-270-0648
Mailing Address - Fax:
Practice Address - Street 1:18700 SE 65TH PL
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8668
Practice Address - Country:US
Practice Address - Phone:425-270-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61094526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61094526OtherWASHINGTON STATE CREDENTIAL