Provider Demographics
NPI:1598778839
Name:TAN, LING HAN (MD)
Entity Type:Individual
Prefix:MS
First Name:LING
Middle Name:HAN
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 1:225 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4928
Mailing Address - Country:US
Mailing Address - Phone:425-822-4633
Mailing Address - Fax:
Practice Address - Street 1:148 PARK AVE N
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-1719
Practice Address - Country:US
Practice Address - Phone:425-255-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1011410Medicaid
D33683Medicare UPIN
0180803Medicare ID - Type Unspecified