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General NPI Number Information
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NPI Number | 1265100101
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Entity Type | Organization
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Legal Business Name | THE FAME FOUNDATION
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Dates
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Enumeration Date | 09/04/2021
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Last Update Date | 09/04/2021
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Provider Practice Location Address
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Address Line | 1946 PASADENA BLVD
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City | PASADENA
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State | TX
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Zip | 77502-2742
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Country | US
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Telephone | 832-203-5992
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Fax | 866-611-7531
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Provider Business Mailing Address
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Address Line | 16610 MYSTIC HARBOR LN
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City | HOUSTON
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State | TX
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Zip | 77095-4597
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Country | US
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Telephone | 346-205-4388
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | DR. SUNDAR ALVIN DHAMOTHARAN
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Credential | MD
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Telephone | 346-205-4388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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