Provider Demographics
NPI:1902478621
Name:THAM, YIENG L
Entity Type:Individual
Prefix:
First Name:YIENG
Middle Name:L
Last Name:THAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WASHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5354
Mailing Address - Country:US
Mailing Address - Phone:617-376-3232
Mailing Address - Fax:617-346-3234
Practice Address - Street 1:111 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5354
Practice Address - Country:US
Practice Address - Phone:617-376-3232
Practice Address - Fax:617-376-3234
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist