MEDICARE: JIE YING TAN MS, RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DX4633	MD

General Provider Information

NPI Number	:	1932743002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIE YING TAN MS, RDN, LD

Provider Business Mailing Address
First Line	:	12001 FERRARA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-4706
Country	:	US
Telephone Number	:	301-946-6623
Fax Number	:	301-946-1107

Provider Business Practice Location Address
First Line	:	12001 FERRARA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-4706
Country	:	US
Telephone Number	:	301-946-6623
Fax Number	:	301-946-1107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

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