Healthcare Provider Details

I. General information

NPI: 1275037103
Provider Name (Legal Business Name): ERIC TAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE A-20
PASADENA CA
91105-3171
US

IV. Provider business mailing address

50 ALESSANDRO PL STE A-20
PASADENA CA
91105-3171
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 855-245-2961
Mailing address:
  • Phone: 188-530-4415
  • Fax: 855-245-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA164896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: