Provider Demographics
NPI:1013942952
Name:TAM, JONATHAN NEI-KIM (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NEI-KIM
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 1:105 N HILL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1934
Mailing Address - Country:US
Mailing Address - Phone:626-449-2800
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:626-449-2800
Practice Address - Fax:626-795-5145
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G660094Medicaid
CA00G660091Medicaid
F01868Medicare UPIN