Provider Demographics
NPI:1780972638
Name:TAN DY, CHERRIE ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERRIE
Middle Name:ROSE
Last Name:TAN DY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERRIE
Other - Middle Name:ROSE
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2790 91ST PL NE
Mailing Address - Street 2:
Mailing Address - City:CLYDE HILL
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1661
Mailing Address - Country:US
Mailing Address - Phone:425-502-8857
Mailing Address - Fax:
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-656-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA637252080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine