Provider Demographics
NPI:1477024164
Name:NHAN TAM MED CLINIC
Entity Type:Organization
Organization Name:NHAN TAM MED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-476-3008
Mailing Address - Street 1:7226 BUFFY LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-3884
Mailing Address - Country:US
Mailing Address - Phone:916-476-3008
Mailing Address - Fax:855-291-3367
Practice Address - Street 1:6830 STOCKTON BLVD STE 155
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2392
Practice Address - Country:US
Practice Address - Phone:916-476-3008
Practice Address - Fax:855-291-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105487OtherMEDICAL LICENSE NUMBER