Healthcare Provider Details

I. General information

NPI: 1942292602
Provider Name (Legal Business Name): JOHN W. TAM D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E ROUTE 66
GLENDORA CA
91740-6241
US

IV. Provider business mailing address

222 E ROUTE 66
GLENDORA CA
91740-6241
US

V. Phone/Fax

Practice location:
  • Phone: 626-914-4661
  • Fax: 626-335-1840
Mailing address:
  • Phone: 626-914-4661
  • Fax: 626-335-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: