Provider Demographics
NPI:1578657292
Name:TAM, SIU-MING (MD)
Entity Type:Individual
Prefix:DR
First Name:SIU-MING
Middle Name:
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5958 BURCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3811
Mailing Address - Country:US
Mailing Address - Phone:408-599-1545
Mailing Address - Fax:
Practice Address - Street 1:13422 NEWPORT AV
Practice Address - Street 2:SUITE I
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3746
Practice Address - Country:US
Practice Address - Phone:714-665-6901
Practice Address - Fax:714-665-6904
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG762712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW676271AMedicare ID - Type Unspecified
CAG01234Medicare UPIN