Healthcare Provider Details

I. General information

NPI: 1174978522
Provider Name (Legal Business Name): PAMELA HUN YIU KUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 MURRIETA BLVD
LIVERMORE CA
94550-4113
US

IV. Provider business mailing address

1134 MURRIETA BLVD
LIVERMORE CA
94550-4113
US

V. Phone/Fax

Practice location:
  • Phone: 925-449-7795
  • Fax:
Mailing address:
  • Phone: 925-449-7795
  • Fax: 925-449-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number157903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: