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General NPI Number Information
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NPI Number | 1104975655
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Entity Type | Individual
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Provider Name | JEANELLE LEILANI KAM MD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 1341 W MOCKINGBIRD LN SUITE 200 E
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City | DALLAS
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State | TX
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Zip | 75247-6913
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Country | US
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Telephone | 214-647-9305
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 W MOCKINGBIRD LN SUITE 200 E
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City | DALLAS
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State | TX
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Zip | 75247-6913
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Country | US
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Telephone | 808-233-9682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A95484
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number | P7790
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License Number State | TX
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