Provider Demographics
NPI:1578631768
Name:THOMAS K S TAN M D INC
Entity Type:Organization
Organization Name:THOMAS K S TAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KA SHUN
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-536-9326
Mailing Address - Street 1:2228 LILIHA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1650
Mailing Address - Country:US
Mailing Address - Phone:808-536-9326
Mailing Address - Fax:808-531-9053
Practice Address - Street 1:2228 LILIHA ST
Practice Address - Street 2:SUITE #103
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1650
Practice Address - Country:US
Practice Address - Phone:808-536-9326
Practice Address - Fax:808-531-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB211108OtherHMSA
HIMD-9783-03OtherMDX - HAWAII
HI192133OtherHMA
HI080992 01Medicaid
HI080992 01Medicaid