Healthcare Provider Details

I. General information

NPI: 1265100101
Provider Name (Legal Business Name): THE FAME FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 PASADENA BLVD
PASADENA TX
77502-2742
US

IV. Provider business mailing address

16610 MYSTIC HARBOR LN
HOUSTON TX
77095-4597
US

V. Phone/Fax

Practice location:
  • Phone: 832-203-5992
  • Fax: 866-611-7531
Mailing address:
  • Phone: 346-205-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNDAR ALVIN DHAMOTHARAN
Title or Position: CMO
Credential: MD
Phone: 346-205-4388