Provider Demographics
NPI:1619652328
Name:TAVE, TAI ANDREW
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:ANDREW
Last Name:TAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22813 LAKEVIEW DR APT F314
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2855
Mailing Address - Country:US
Mailing Address - Phone:425-244-2279
Mailing Address - Fax:
Practice Address - Street 1:22813 LAKEVIEW DR APT F314
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2855
Practice Address - Country:US
Practice Address - Phone:425-244-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist