MEDICARE: JIMMY CHAM DDS A PROFESSIONAL CORPORATION

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	122300000X	Dentist	37088	CA

General Provider Information

NPI Number	:	1104027614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMMY CHAM DDS A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2139 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1346
Country	:	US
Telephone Number	:	408-259-5660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 TULLY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1346
Country	:	US
Telephone Number	:	408-259-5660
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIMMY CHAM
Credential	:	D.D.S.
Telephone Number	:	408-259-5660

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	03/16/2020

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