JIA WEI TAN (Credential# 2035623) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is June 22, 2020. The license expiration date date is June 30, 2023. The license status is ACTIVE.
JIA WEI TAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.065248-RES. The credential type is resident physician. The effective date is June 22, 2020. The expiration date is June 30, 2023. The business address is 267 Grant St, Bridgeport, CT 06610-2805. The current status is active.
| Licensee Name | JIA WEI TAN |
| Credential ID | 2035623 |
| Credential Number | 1.065248-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
267 Grant St Bridgeport CT 06610-2805 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2020-06-22 |
| Effective Date | 2020-06-22 |
| Expiration Date | 2023-06-30 |
| Refresh Date | 2020-04-17 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 2036245 | CSP.0073695 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2020-04-17 | 2020-04-17 - 2021-02-28 | ACTIVE |
| Street Address | 267 GRANT ST |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06610-2805 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lauren Roth | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2024-06-30 |
| Madeline Carmain | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2024-06-30 |
| Aishwariya S Vegunta | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Rasha T Ismail | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Mark Steven Mcfarland | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2018-07-01 ~ 2023-06-30 |
| Benjamin Hans Jeuk | 267 Grant St, Bridgeport, CT 06610 | Resident Physician | 2020-06-22 ~ 2023-06-30 |
| Lucia Plichtova | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2023-06-30 |
| Kwabena Sefah Nketiah Sarpong | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2023-06-30 |
| Prajna D'silva | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2023-06-30 |
| Fabricio Malaguez Webber | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2023-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Gilead I Lancaster Md | 267 Grant St Fl 10, Bridgeport, CT 06610-2805 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Nabil A Atweh | 267 Grant St Fl 8, Bridgeport, CT 06610-2805 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Edwin Jin Su Lee | 297 Grant St, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2017-08-11 ~ 2019-02-28 |
| Wilhelmina Jackson | 226 Mill Hill Ave., Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Joanna Zolkowski-wynne | 267 Grant St # 5000, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mohammad A Younus | 287 Grant St, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Maximilian Klein | Bridgeport Hospital, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Edosa I Odaro | 267 Grant Street, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nilca Janice Cardenales | 66 Rose St, Bridgeport, CT 06610 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Kiara Lizbeth Corporan | 10 Sturtevant Pl, Bridgeport, CT 06610 | Eyelash Technician | ~ |
| Alisha Garcia | 65 Berkeley Place, Bridgeport, CT 06610 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Pauline Parkes | 96 Virginia Avenue, Bridgeport, CT 06610 | Licensed Clinical Social Worker | ~ |
| Denise Reyes | 1125 Huntington Turnpike, Bridgeport, CT 06610 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Avery M Rilley | 80 Granfield Avenue, Bridgeport, CT 06610 | Pharmacy Technician | 2020-06-25 ~ 2021-03-31 |
| Bozena K. Malyszko | Bridgeport Hospital, Bridgeport, CT 06610 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Amy Espinosa | 146 Court D, Bridgeport, CT 06610 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Wilhelmina Jackson · Thomas | 172 Court D, Bridgeport, CT 06610 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Emma Agyeiwaa Vaczek | P.o Box 5223, Bridgeport, CT 06610 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06610 | |||
| City | BRIDGEPORT |
| Zip Code | 06610 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + BRIDGEPORT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jin Woo Yoo | 44 Orange St Apt 317, New Haven, CT 06510 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Jennifer A Guy | 6 Early Dr Apt K, Watervliet, NY 12189-2517 | Resident Physician | ~ |
| Victoria Parker | CT | Resident Physician | 2015-06-23 ~ 2021-06-30 |
| Tao Zuo | 20 York St., New Haven, CT 06510-3220 | Resident Physician | 2016-07-25 ~ 2020-06-30 |
| Yan Zhu | 27 Brainerd Rd # B, Branford, CT 06405-6302 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Gin Yi Lee | 24 Hospital Ave, Danbury, CT 06810-6099 | Resident Physician | 2019-06-20 ~ 2022-06-30 |
| Edward Lee | 20 York St, New Haven, CT 06510 | Resident Physician | 2020-06-24 ~ 2021-06-30 |
| Gal Yaniv | 20 York St., New Haven, CT 06510-3220 | Resident Physician | 2016-07-01 ~ 2019-06-30 |
| Mingwei Yu | 24 Hospital Ave, Danbury, CT 06810-6099 | Resident Physician | 2019-06-20 ~ 2022-06-30 |
| Annie Ong | 56 Franklin St, Waterbury, CT 06706-1253 | Resident Physician | 2018-06-19 ~ 2021-06-22 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).