Provider Demographics
NPI:1891115325
Name:TAN, YONG (MD)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 HARRY HINES BLVD POB 1-10TH FLOOR SUITE HP10-110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8879
Mailing Address - Country:US
Mailing Address - Phone:214-645-7700
Mailing Address - Fax:
Practice Address - Street 1:5959 HARRY HINES BLVD HP10-110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2238
Practice Address - Country:US
Practice Address - Phone:214-645-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.34915208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program