Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | 18013 | HI |
N | 207YS0123X | Facial Plastic Surgeon | 18013 | HI |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 18013 | HI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 18013 | HI |
NPI | 1457731358 |
---|---|
Provider Name | Dr. Susan Lei Tan |
First Address | Coquitlam, BC V3E2X3 |
Second Address | Honolulu, HI 96826-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 05/06/2015 |