Provider Demographics
NPI:1558194035
Name:KWEI HAM DANIEL TAN, DO PLLC
Entity type:Organization
Organization Name:KWEI HAM DANIEL TAN, DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-777-0333
Mailing Address - Street 1:417 S JENSEN RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3018
Mailing Address - Country:US
Mailing Address - Phone:772-777-0333
Mailing Address - Fax:347-719-8000
Practice Address - Street 1:120 SYKES ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1231
Practice Address - Country:US
Practice Address - Phone:607-591-5349
Practice Address - Fax:607-428-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty