Provider Demographics
NPI:1558587915
Name:TAN, JANE SOON-YUEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:SOON-YUEN
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 1:3211 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-0907
Mailing Address - Country:US
Mailing Address - Phone:770-787-4042
Mailing Address - Fax:770-922-7499
Practice Address - Street 1:3211 IRIS DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-0907
Practice Address - Country:US
Practice Address - Phone:770-787-4042
Practice Address - Fax:770-922-7499
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072828207X00000X, 207XS0106X, 207X00000X
UT6986591-1205207XS0106X
MI4301081710207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154151AMedicaid
GA003154151AMedicaid