Individual
MICHELLE DAYOUNG BAEK TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
10624 S EASTERN AVE STE A-955, HENDERSON, NV 89052-2982
(702) 800-5393
Mailing address
10624 S EASTERN AVE STE A-955, HENDERSON, NV 89052-2982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO3484
NV
208D00000X
General Practice Physician
3484
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255919346
—
NV
Enumeration date
03/30/2021
Last updated
10/30/2024
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