Healthcare Provider Details

I. General information

NPI: 1972732014
Provider Name (Legal Business Name): KIT WAH TAM M.D., M.H.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 45TH STREET
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

4501 X STREET SUITE 3016
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5959
  • Fax: 916-703-5265
Mailing address:
  • Phone: 916-734-3772
  • Fax: 916-734-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA126094
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA126094
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA126094
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA126094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: