Healthcare Provider Details

I. General information

NPI: 1932743002
Provider Name (Legal Business Name): JIE YING TAN MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 FERRARA AVE
SILVER SPRING MD
20906-4706
US

IV. Provider business mailing address

12001 FERRARA AVE
SILVER SPRING MD
20906-4706
US

V. Phone/Fax

Practice location:
  • Phone: 301-946-6623
  • Fax: 301-946-1107
Mailing address:
  • Phone: 301-946-6623
  • Fax: 301-946-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: