Healthcare Provider Details

I. General information

NPI: 1346381654
Provider Name (Legal Business Name): JANICE CAROL TAM DDS MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 OCEAN AVE STE 102
SAN FRANCISCO CA
94127-2618
US

IV. Provider business mailing address

2411 OCEAN AVE STE 102
SAN FRANCISCO CA
94127-2618
US

V. Phone/Fax

Practice location:
  • Phone: 415-508-9468
  • Fax: 415-859-5800
Mailing address:
  • Phone: 415-508-9468
  • Fax: 415-859-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number35083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: