Provider Demographics
NPI:1598351546
Name:TAN, KAYLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LIU
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6460
Mailing Address - Fax:903-416-6461
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 240
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4588
Practice Address - Country:US
Practice Address - Phone:903-416-6460
Practice Address - Fax:903-416-6461
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1158892363A00000X
TXPA14454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant