Provider Demographics
NPI:1629287131
Name:TOM, JAMES WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:TOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W 34TH ST
Mailing Address - Street 2:DEN 4302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0058
Mailing Address - Country:US
Mailing Address - Phone:213-740-1081
Mailing Address - Fax:310-474-1605
Practice Address - Street 1:925 W 34TH ST
Practice Address - Street 2:DEN 4302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0058
Practice Address - Country:US
Practice Address - Phone:213-740-1081
Practice Address - Fax:310-474-1605
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496841223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist