Provider Demographics
NPI:1972937522
Name:THOMAS TAN MD PC
Entity Type:Organization
Organization Name:THOMAS TAN MD PC
Other - Org Name:THOMAS U TAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:U
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-735-9001
Mailing Address - Street 1:7103 W GRANDRIDGE BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6713
Mailing Address - Country:US
Mailing Address - Phone:509-735-9001
Mailing Address - Fax:
Practice Address - Street 1:7103 W GRANDRIDGE BLVD
Practice Address - Street 2:STE D
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6713
Practice Address - Country:US
Practice Address - Phone:509-735-9001
Practice Address - Fax:509-735-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109073Medicaid
WA1109073Medicaid
WAGAB13747Medicare PIN