Provider Demographics
NPI:1376624023
Name:FUNG TAM, NANCY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:FUNG TAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70442
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-7442
Mailing Address - Country:US
Mailing Address - Phone:213-247-4283
Mailing Address - Fax:
Practice Address - Street 1:16350 FILBERT ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1002
Practice Address - Country:US
Practice Address - Phone:818-364-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist