Healthcare Provider Details

I. General information

NPI: 1447430970
Provider Name (Legal Business Name): CHARLES TAM MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 L ST
BAKERSFIELD CA
93301-2337
US

IV. Provider business mailing address

2520 L ST
BAKERSFIELD CA
93301-2337
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-9500
  • Fax: 661-328-0938
Mailing address:
  • Phone: 661-328-9500
  • Fax: 661-328-0938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA19706
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA19706
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberA19706
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES T C TAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 661-328-9500