Provider Demographics
NPI:1649961855
Name:TAN, ISAAC ZHI YONG
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:ZHI YONG
Last Name:TAN
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 1:1700 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6048
Mailing Address - Country:US
Mailing Address - Phone:507-720-0920
Mailing Address - Fax:507-720-0868
Practice Address - Street 1:1700 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6048
Practice Address - Country:US
Practice Address - Phone:507-720-0920
Practice Address - Fax:507-720-0868
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician