Healthcare Provider Details

I. General information

NPI: 1942352141
Provider Name (Legal Business Name): ROLAND FOOK SENG TAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LILIHA ST SUITE 409
HONOLULU HI
96817-1650
US

IV. Provider business mailing address

2228 LILIHA ST SUITE 409
HONOLULU HI
96817-1650
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-7021
  • Fax: 808-531-7022
Mailing address:
  • Phone: 808-531-7021
  • Fax: 808-531-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD3110
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: