Provider Demographics
NPI:1558451815
Name:KAM, SAM SHEUNG TSAM (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:SHEUNG TSAM
Last Name:KAM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17170 COLIMA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6771
Mailing Address - Country:US
Mailing Address - Phone:626-810-5601
Mailing Address - Fax:626-810-2556
Practice Address - Street 1:17170 COLIMA RD
Practice Address - Street 2:SUITE E
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6771
Practice Address - Country:US
Practice Address - Phone:626-810-5601
Practice Address - Fax:626-810-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65063207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G650630Medicaid
G65063Medicare ID - Type Unspecified
CA00G650630Medicaid