Provider Demographics
NPI:1548270390
Name:TAM, ALLEN WAI-HUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:WAI-HUNG
Last Name:TAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 NE MASON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3504
Mailing Address - Country:US
Mailing Address - Phone:503-804-7049
Mailing Address - Fax:
Practice Address - Street 1:1939 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1917
Practice Address - Country:US
Practice Address - Phone:503-252-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice