Individual
DR. KIMTY TAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1018 W LEHIGH AVE, PHILADELPHIA, PA 19133-1640
(215) 227-1881
Mailing address
5761 N 6TH ST, PHILADELPHIA, PA 19120-2201
(215) 924-8056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS026581-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011577740002
—
PA
Enumeration date
08/22/2005
Last updated
07/08/2007
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