Provider Demographics
NPI:1689715716
Name:TAM, DANIEL TIN-YUEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TIN-YUEN
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:665 CAMINO DE LOS MARES
Mailing Address - Street 2:STE. 665
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2859
Mailing Address - Country:US
Mailing Address - Phone:949-492-3111
Mailing Address - Fax:949-493-0811
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:STE. 305
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2859
Practice Address - Country:US
Practice Address - Phone:949-493-0811
Practice Address - Fax:949-493-0134
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34833207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46109Medicare UPIN