Provider Demographics
NPI:1386922359
Name:CHIN-TAN, JESSICA MON (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MON
Last Name:CHIN-TAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14205 ROOSEVELT AVE
Mailing Address - Street 2:APT 112
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6005
Mailing Address - Country:US
Mailing Address - Phone:917-903-9469
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:14205 ROOSEVELT AVE UNIT 112
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1135
Practice Address - Country:US
Practice Address - Phone:646-653-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine