Provider Demographics
NPI:1699885731
Name:TAI, OLIVER SHU-ON (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:SHU-ON
Last Name:TAI
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 1:1840 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:855-397-0197
Mailing Address - Fax:800-272-6512
Practice Address - Street 1:2707 COLBY AVE STE 718
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3528
Practice Address - Country:US
Practice Address - Phone:425-339-5413
Practice Address - Fax:425-339-4213
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042454207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8365280Medicaid
WA0237891OtherL&I
WA8365280OtherDSHS
WA8365280Medicaid
WA8365280OtherDSHS