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NPI Code Detail

MEDICARE: DR. CHONG-YANG TAN D.O.

MEDICARE: DR. CHONG-YANG TAN D.O.
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
1207Q00000XFamily Medicine Physician4111AZ
2207Q00000XFamily Medicine PhysicianOP.60060138WA

General Provider Information

NPI Number : 1588691521
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHONG-YANG TAN D.O.
Provider Business Mailing Address
First Line : 12607 SE MILL PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98684-6055
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12607 SE MILL PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98684-6055
Country : US
Telephone Number : 480-694-9443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 02/04/2022

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Directions to “ DR. CHONG-YANG TAN D.O.” Practice Location

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