Healthcare Provider Details

I. General information

NPI: 1679485627
Provider Name (Legal Business Name): ARIEL TAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WALNUT AVE STE 290
FREMONT CA
94538-2215
US

IV. Provider business mailing address

3340 WALNUT AVE STE 290
FREMONT CA
94538-2215
US

V. Phone/Fax

Practice location:
  • Phone: 510-213-8336
  • Fax:
Mailing address:
  • Phone: 510-213-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-457991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: