Provider Demographics
NPI:1265766166
Name:JONATHAN TAM MD INC
Entity type:Organization
Organization Name:JONATHAN TAM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-449-3263
Mailing Address - Street 1:105 N HILL AVE #203
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3487
Mailing Address - Country:US
Mailing Address - Phone:626-449-3263
Mailing Address - Fax:626-795-5145
Practice Address - Street 1:105 N HILL AVE STE 203
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1934
Practice Address - Country:US
Practice Address - Phone:626-449-3263
Practice Address - Fax:626-795-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G660091Medicaid
CA00G660094Medicaid
CA00G660094Medicaid