Provider Demographics
NPI:1003964826
Name:KAM, WING K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WING
Middle Name:K
Last Name:KAM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:WING
Other - Middle Name:KAM
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:G I UNIT L103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-831-8383
Mailing Address - Fax:415-831-6988
Practice Address - Street 1:3838 CALIFORNIA ST RM 108
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1504
Practice Address - Country:US
Practice Address - Phone:415-831-8383
Practice Address - Fax:415-831-6988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43959207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE88492Medicare UPIN
CAG439590Medicare ID - Type Unspecified