Provider Demographics
NPI:1740429257
Name:TAN, JOCELYN (JOCELYN TAN)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:JOCELYN TAN
Other - Prefix:DR
Other - First Name:HUIPING
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JOCELYN HUIPING TAN
Mailing Address - Street 1:30 CENTRAL PARK S RM 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:917-608-4985
Mailing Address - Fax:
Practice Address - Street 1:630 5TH AVE STE 1810
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10111-1877
Practice Address - Country:US
Practice Address - Phone:917-608-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-08
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053229-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics