Provider Demographics
NPI:1407250442
Name:KANG, TAM (PA-C)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 W WHEATLAND RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3404
Mailing Address - Country:US
Mailing Address - Phone:972-283-5998
Mailing Address - Fax:972-283-2498
Practice Address - Street 1:3920 W WHEATLAND RD STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3404
Practice Address - Country:US
Practice Address - Phone:972-283-5998
Practice Address - Fax:972-283-2498
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5852363AM0700X
TXPA11202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical