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Organization
TANTAM MEDICAL GROUP, INC.
Active
Organization
TANTAM MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PUMIPAK TANTAMJARIK MD, FAAFP (PHYSICIAN)
(714) 641-1610
Entity
Organization
Contact information
Practice address
1610 W EDINGER AVE STE B, SANTA ANA, CA 92704-4339
(714) 641-1610
(714) 641-1146
Mailing address
1610 W EDINGER AVE STE B, SANTA ANA, CA 92704-4339
(714) 641-1610
(714) 641-1146
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A71362
CA
208000000X
Pediatrics Physician
A31595
CA
208D00000X
General Practice Physician
A31442
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0027840
—
CA
Enumeration date
09/08/2005
Last updated
02/23/2023
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