Basic Information
| Provider Information | |||||||||
| NPI: | 1376500793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TSANG | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAU | ||||||||
| OtherFirstName: | JOAN | ||||||||
| OtherMiddleName: | CHUNG KI | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9230 SKY ISLAND DR E | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983917385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537506000 | ||||||||
| FaxNumber: | 2537506100 | ||||||||
| Practice Location | |||||||||
| Address1: | 9230 SKY ISLAND DR E | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983917385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537506000 | ||||||||
| FaxNumber: | 2537506100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 04/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 60587855 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 100373060K | 05 | KS | MEDICAID | 003719209 | 01 | MEDICARE | OTHER |