Provider Demographics
NPI:1225741382
Name:TAM, LONG YIN (PA)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:YIN
Last Name:TAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3949
Mailing Address - Country:US
Mailing Address - Phone:510-612-8813
Mailing Address - Fax:
Practice Address - Street 1:1050 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3949
Practice Address - Country:US
Practice Address - Phone:510-612-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant