Provider Demographics
NPI:1356830137
Name:TAM, SHIN HAN JUDY
Entity Type:Individual
Prefix:
First Name:SHIN HAN JUDY
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17192 MURPHY AVE, PO BOX 14115
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623
Mailing Address - Country:US
Mailing Address - Phone:949-732-8394
Mailing Address - Fax:
Practice Address - Street 1:17911 SKY PARK CIR STE E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4303
Practice Address - Country:US
Practice Address - Phone:949-202-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-06-19
Deactivation Date:2023-05-04
Deactivation Code:
Reactivation Date:2023-06-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician