Healthcare Provider Details

I. General information

NPI: 1487592325
Provider Name (Legal Business Name): TJ KLAY SANDUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

17010 E DESMET CT APT O105
SPOKANE VALLEY WA
99216-3586
US

V. Phone/Fax

Practice location:
  • Phone: 561-850-6366
  • Fax:
Mailing address:
  • Phone: 425-282-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: