Provider Demographics
NPI:1124038757
Name:TAM, ANITA SHUK WAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:SHUK WAI
Last Name:TAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1295 BLACKSTONE RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2718
Mailing Address - Country:US
Mailing Address - Phone:626-287-7625
Mailing Address - Fax:
Practice Address - Street 1:3065 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-5333
Practice Address - Country:US
Practice Address - Phone:626-961-6205
Practice Address - Fax:626-961-6206
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA333851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice