MEDICARE: TAM KANG PA-C

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	363AM0700X	Medical Physician Assistant	5852	AZ
2	363A00000X	Physician Assistant	PA11202	TX

General Provider Information

NPI Number	:	1407250442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAM KANG PA-C

Provider Business Mailing Address
First Line	:	3920 W WHEATLAND RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3404
Country	:	US
Telephone Number	:	972-283-5998
Fax Number	:	972-283-2498

Provider Business Practice Location Address
First Line	:	3920 W WHEATLAND RD STE 140
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3404
Country	:	US
Telephone Number	:	972-283-5998
Fax Number	:	972-283-2498

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

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	09/04/2019

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Directions to “ TAM KANG PA-C” Practice Location

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