Basic Information
| Provider Information | |||||||||
| NPI: | 1982733861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAN | ||||||||
| FirstName: | BICH | ||||||||
| MiddleName: | NGOC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4420 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197847093 | ||||||||
| FaxNumber: | 9197847395 | ||||||||
| Practice Location | |||||||||
| Address1: | 4420 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197847093 | ||||||||
| FaxNumber: | 9197847395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 121514 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2007-00089 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 200700089 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 2007-00089 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.