MEDICARE: DR. AMY SIU-YIN TAM DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	102414	CA

General Provider Information

NPI Number	:	1477939023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY SIU-YIN TAM DDS

Provider Business Mailing Address
First Line	:	5700 FULTON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-3443
Country	:	US
Telephone Number	:	415-254-0817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1871 CAMDEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2945
Country	:	US
Telephone Number	:	408-796-3109
Fax Number	:

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	05/08/2018

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