Provider Demographics
NPI:1588872303
Name:TAN, JOSEPH SOONHOW (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SOONHOW
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-0483612085R0202X
HIMD175102085R0202X
CO491472085R0202X
NE257742085R0202X
KS04-363522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025709000Medicaid
IA1588872303Medicaid
OK200503590 AMedicaid
NC7617659Medicaid
NE84059792913Medicaid
IL1588872303Medicaid
UT1588872303Medicaid
SD1588872303Medicaid
NE84089712600Medicaid
OH0062767Medicaid
MO1588872303Medicaid
WY1588872303Medicaid
AZ619746Medicaid
CO77777875Medicaid
KSKA3249055Medicare PIN
UT1588872303Medicaid
COCOA104282Medicare PIN
NE10025709000Medicaid
IA1588872303Medicaid
KS111257050Medicare PIN
NENA2517060Medicare PIN
CO392302ZLJ3Medicare PIN
NC7617659Medicaid
WY1588872303Medicaid