MEDICARE: WINNIE WING YI TAM

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	1041C0700X	Clinical Social Worker	92082	CA

General Provider Information

NPI Number	:	1437782125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINNIE WING YI TAM

Provider Business Mailing Address
First Line	:	6029 COZZENS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-3726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6029 COZZENS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-3726
Country	:	US
Telephone Number	:	626-780-6511
Fax Number	:

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

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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Directions to “ WINNIE WING YI TAM ” Practice Location

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