Provider Demographics
NPI:1225229529
Name:TAN, LIZA BEE KUN (MB BCH BAO)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:BEE KUN
Last Name:TAN
Suffix:
Gender:F
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W UNIVERSITY PKWY
Mailing Address - Street 2:BROADVIEW APARTMENT #1034
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-3305
Mailing Address - Country:US
Mailing Address - Phone:443-414-3363
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:BLALOCK 655
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-855-0834
Practice Address - Fax:410-955-0834
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program