Provider Demographics
NPI:1376500793
Name:TSANG, JOAN C (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:TSANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:CHUNG KI
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9230 SKY ISLAND DR E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7385
Mailing Address - Country:US
Mailing Address - Phone:253-750-6000
Mailing Address - Fax:253-750-6100
Practice Address - Street 1:9230 SKY ISLAND DR E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7385
Practice Address - Country:US
Practice Address - Phone:253-750-6000
Practice Address - Fax:253-750-6100
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60587855208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100373060KMedicaid
003719209OtherMEDICARE
KS100373060KMedicaid