Healthcare Provider Details

I. General information

NPI: 1306799051
Provider Name (Legal Business Name): THOMAS H BEAM MPSS-DCKAHJ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

12888 NEUGEBAUER RD SPC 29
STOCKTON CA
95206-9536
US

V. Phone/Fax

Practice location:
  • Phone: 209-208-5346
  • Fax:
Mailing address:
  • Phone: 209-546-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number175T00000X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: