Active NPI
Kee Ming Tan, DMD
- Dentist
- Birmingham, AL
National Provider Identifier
1124409602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6189
- Practice address
- 617 19TH CT S
Birmingham, AL 35205-6405 - Phone
- (205) 243-0073
- NPI assigned
- Jun 10, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6189 | AL | Primary |
Addresses
Primary practice location
617 19TH CT S
Birmingham, AL 35205-6405
Mailing address
617 19TH CT S
Birmingham, AL 35205-6405
Phone (205) 243-0073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160108000669 | AL | Order and Referring Only - Oral Surgery | 5193027027 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6189 | AL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433894400000",
"number": "1124409602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 19TH CT S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352056405",
"telephone_number": "205-243-0073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 19TH CT S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352056405",
"telephone_number": "205-243-0073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "KEE",
"middle_name": "MING",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-10",
"last_updated": "2015-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "6189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.