Provider Demographics
NPI:1477521409
Name:TAN, KATHY SHAOBING (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:SHAOBING
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAOBING
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5324 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3121
Mailing Address - Country:US
Mailing Address - Phone:718-686-6888
Mailing Address - Fax:718-686-6887
Practice Address - Street 1:5324 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3121
Practice Address - Country:US
Practice Address - Phone:718-686-6888
Practice Address - Fax:718-686-6887
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02590807Medicaid
NY047SA1Medicare ID - Type Unspecified
NYI19914Medicare UPIN