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NPI Code Detail

MEDICARE: ANITA TAM DDS INC

MEDICARE: ANITA TAM DDS INC
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
1261QD0000XDental Clinic/Center2348874CA

General Provider Information

NPI Number : 1356358063
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANITA TAM DDS INC
Provider Business Mailing Address
First Line : 3065 S HACIENDA BLVD
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-5333
Country : US
Telephone Number : 626-961-6205
Fax Number : 626-961-6206
Provider Business Practice Location Address
First Line : 3065 S HACIENDA BLVD
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-5333
Country : US
Telephone Number : 626-961-6205
Fax Number : 626-961-6206
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANITA TAM
Credential : DDS
Telephone Number : 626-961-6205
Provider Enumeration Date : 08/02/2006
Last Update Date : 09/09/2013

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Directions to “ANITA TAM DDS INC ” Practice Location

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