MEDICARE: KEITH H 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
1	1223P0221X	Pediatric Dentistry	57293	CA

General Provider Information

NPI Number	:	1497009831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH H TAM DDS INC

Provider Business Mailing Address
First Line	:	2674 SAN MIGUEL DR STE C
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	949-478-6628
Fax Number	:

Provider Business Practice Location Address
First Line	:	2674 SAN MIGUEL DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	949-478-6628
Fax Number	:

Authorized Official
Title or Position	:	OWNER, DDS
Name	:	DR. KEITH H TAM
Credential	:	DDS
Telephone Number	:	949-322-9778

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	01/27/2022

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