Provider Demographics
NPI:1093371478
Name:TAI, FION (WHNP-BC)
Entity type:Individual
Prefix:
First Name:FION
Middle Name:
Last Name:TAI
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 TUSTIN FIELD DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-6523
Mailing Address - Country:US
Mailing Address - Phone:505-480-7575
Mailing Address - Fax:
Practice Address - Street 1:279 TUSTIN FIELD DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-6523
Practice Address - Country:US
Practice Address - Phone:505-480-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-12
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011151363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health