Individual
LAI WAN TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2512 WHEATON WAY, BREMERTON, WA 98310-3303
(360) 782-3700
Mailing address
2512 WHEATON WAY, BREMERTON, WA 98310-3303
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00036150
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110216790
RAILROAD MEDICARE
—
01
—
144839
LABOR & INDUSTRIES
—
01
—
1918TA
REGENCE BLUESHIELD
—
01
—
5274746
AETNA
—
05
—
8277956
—
WA
Enumeration date
06/23/2006
Last updated
03/07/2023
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