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General NPI Number Information
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NPI Number | 1770694713
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Entity Type | Organization
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Legal Business Name | LAKEWOOD PEDIATRIC ASSOCIATES, PLLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 7424 BRIDGEPORT WAY W STE 103
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City | LAKEWOOD
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State | WA
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Zip | 98499
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Country | US
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Telephone | 253-581-2111
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Fax | 253-581-7479
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Provider Business Mailing Address
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Address Line | 7424 BRIDGEPORT WAY W STE 103
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City | LAKEWOOD
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State | WA
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Zip | 98499
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Country | US
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Telephone | 253-581-2111
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Fax | 253-581-7479
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DARRYL TAN
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Credential | M.D.
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Telephone | 253-581-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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