Provider Demographics
NPI:1932187473
Name:TAM, KIM H (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:H
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-342-8115
Mailing Address - Fax:704-344-2691
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 440
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-342-8115
Practice Address - Fax:704-344-2691
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C89543Medicare ID - Type Unspecified