MEDICARE: TOM KY 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	207R00000X	Internal Medicine Physician	A81281	CA

General Provider Information

NPI Number	:	1558397869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM KY M.D.

Provider Business Mailing Address
First Line	:	16891 MOUNT CITADEL ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3013
Country	:	US
Telephone Number	:	714-675-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4512
Country	:	US
Telephone Number	:	562-933-2000
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/03/2021

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