Provider Demographics
NPI:1669506473
Name:KENGLA, ALICE TAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:TAM
Last Name:KENGLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:MEDICAL ONCOLOGY AND HEMATOLOGY
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-4575
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:MEDICAL ONCOLOGY AND HEMATOLOGY
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-12-14
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83097207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine