Provider Demographics
NPI:1982727376
Name:TAN, ROSEMARIE CHIONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:CHIONG
Last Name:TAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 WAIALAE AVE
Mailing Address - Street 2:SUITE 370B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5842
Mailing Address - Country:US
Mailing Address - Phone:808-738-6571
Mailing Address - Fax:
Practice Address - Street 1:92-605 MAKAKILO DR
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1288
Practice Address - Country:US
Practice Address - Phone:808-672-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT24641223X0400X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9183868Medicaid
IL1878163OtherUNITED CONCORDIA