=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235273327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL T. TAM, M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 09/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 665 CAMINO DE LOS MARES STE 305
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-2841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-493-0811
-----------------------------------------------------
Fax | 949-493-0134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 665 CAMINO DE LOS MARES STE 305
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-2859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-493-0811
-----------------------------------------------------
Fax | 949-493-0134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL T. TAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-493-0811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | G34833
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------