Provider Demographics
NPI:1821339532
Name:TAYAN, TEDDY
Entity Type:Individual
Prefix:
First Name:TEDDY
Middle Name:
Last Name:TAYAN
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 1:6700 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1895
Mailing Address - Country:US
Mailing Address - Phone:907-929-0304
Mailing Address - Fax:
Practice Address - Street 1:6700 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1895
Practice Address - Country:US
Practice Address - Phone:907-929-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider