MEDICARE: DR. KWOK LING KAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	32380	OK
2	207ZN0500X	Neuropathology Physician	125.071640	IL

General Provider Information

NPI Number	:	1023566288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWOK LING KAM

Provider Business Mailing Address
First Line	:	719 NE 14TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E OHIO ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	415-527-8670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	12/24/2018

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Directions to “ DR. KWOK LING KAM ” Practice Location

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