Provider Demographics
NPI:1285708347
Name:TAN, THOMAS UY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:UY
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7103 W GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE 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:509-735-9277
Practice Address - Street 1:7103 W GRANDRIDGE BLVD
Practice Address - Street 2:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036949207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109073Medicaid
F05003Medicare UPIN
WAGAB13747Medicare ID - Type Unspecified