MEDICARE: MISS WING YIN TAM M.S.O.M

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	171100000X	Acupuncturist	AC 9037	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619033230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS WING YIN TAM M.S.O.M

Provider Business Mailing Address
First Line	:	12626 RIVERSIDE DR
Second Line	:	SUITE 508
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3420
Country	:	US
Telephone Number	:	626-688-1439
Fax Number	:

Provider Business Practice Location Address
First Line	:	12626 RIVERSIDE DR
Second Line	:	SUITE 508
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3420
Country	:	US
Telephone Number	:	626-688-1439
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	04/26/2014

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