MEDICARE: DR. ALLEN WAI-HUNG TAM D.M.D.

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	1223G0001X	General Practice Dentistry	D8347	OR

General Provider Information

NPI Number	:	1548270390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN WAI-HUNG TAM D.M.D.

Provider Business Mailing Address
First Line	:	9605 NE MASON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-3504
Country	:	US
Telephone Number	:	503-804-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 NE 122ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-1917
Country	:	US
Telephone Number	:	503-252-3666
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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