MEDICARE: JEANELLE LEILANI KAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A95484	CA
2	208U00000X	Clinical Pharmacology Physician	P7790	TX

General Provider Information

NPI Number	:	1104975655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANELLE LEILANI KAM MD

Provider Business Mailing Address
First Line	:	1341 W MOCKINGBIRD LN
Second Line	:	SUITE 200 E
City	:	DALLAS
State	:	TX
Zip	:	75247-6913
Country	:	US
Telephone Number	:	808-233-9682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 W MOCKINGBIRD LN
Second Line	:	SUITE 200 E
City	:	DALLAS
State	:	TX
Zip	:	75247-6913
Country	:	US
Telephone Number	:	214-647-9305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	03/01/2017

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