Basic Information
| Provider Information | |||||||||
| NPI: | 1962608539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAN | ||||||||
| FirstName: | SABRINA | ||||||||
| MiddleName: | K.G. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 MLK JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537926111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 MLK JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537926111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 12/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60624958 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | MDR-5298 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | MD-15762 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207R00000X | MD60624958 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.