Healthcare Provider Details

I. General information

NPI: 1821915398
Provider Name (Legal Business Name): TAM H NGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S 1ST ST
OLEAN NY
14760-3502
US

IV. Provider business mailing address

124 S 1ST ST
OLEAN NY
14760-3502
US

V. Phone/Fax

Practice location:
  • Phone: 310-729-5425
  • Fax:
Mailing address:
  • Phone: 310-729-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: