Provider Demographics
NPI:1598100950
Name:TAN, SARAH RIA (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RIA
Last Name:TAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RIA TAN
Other - Last Name:KUHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2628
Mailing Address - Country:US
Mailing Address - Phone:651-464-7100
Mailing Address - Fax:
Practice Address - Street 1:1540 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2628
Practice Address - Country:US
Practice Address - Phone:651-464-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68925207Q00000X
WI65706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine