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KWEI HAM DANIEL TAN, DO, PLLC

Company Details

Name: KWEI HAM DANIEL TAN, DO, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 31 Jul 2024 (10 months ago)
Entity Number: 7387176
ZIP code: 11762
County: Broome
Place of Formation: New York
Address: po box 175, MASSAPEQUA PARK, NY, United States, 11762

Contact Details

Phone +1 607-898-5876

DOS Process Agent

Name Role Address
the llc DOS Process Agent po box 175, MASSAPEQUA PARK, NY, United States, 11762

National Provider Identifier

NPI Number:
1558194035
Certification Date:
2024-08-21

Authorized Person:

Name:
WINDA DICKEY
Role:
BILLING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3477198000
Fax:
6074285077

Filings

Filing Number Date Filed Type Effective Date
240801037896 2024-07-31 ARTICLES OF ORGANIZATION 2024-07-31

Date of last update: 19 Mar 2025

Sources: New York Secretary of State