Provider Demographics
NPI:1578713707
Name:TAN, JESSICA SUHUI (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUHUI
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 1:1000 FRANKLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1922
Mailing Address - Country:US
Mailing Address - Phone:650-299-2181
Mailing Address - Fax:
Practice Address - Street 1:1000 FRANKLIN PKWY
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1922
Practice Address - Country:US
Practice Address - Phone:650-299-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115558207R00000X, 207K00000X
HI16139207R00000X
OH35096723207R00000X
OH57-014949390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3130203Medicaid
OH4315431Medicare PIN