Healthcare Provider Details

I. General information

NPI: 1467193284
Provider Name (Legal Business Name): LYDIA TIN-WEI TAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH STREET, 4TH FLOOR BOX 0110 UNIVERSITY OF CALIFORNIA SAN FRANCISCO
SAN FRANCISCO CA
94158
US

IV. Provider business mailing address

550 16TH STREET, 4TH FLOOR BOX 0110 DEPT OF PEDIATRICS, UNIV OF CALIFORNIA SAN FRANCISCO
SAN FRANCISCO CA
94158
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3565
  • Fax:
Mailing address:
  • Phone: 415-476-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61298437
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA202041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: