Individual
JONATHAN TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4650 W SUNSET BLVD, MS#75, LOS ANGELES, CA 90027-6062
(323) 361-2501
(323) 361-1191
Mailing address
4650 W SUNSET BLVD, MS#75, LOS ANGELES, CA 90027-6062
(323) 361-2501
(323) 361-1191
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
A125923
CA
208000000X
Pediatrics Physician
125-052818
IL
208000000X
Pediatrics Physician
54495
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125-052818
ILLINOIS LICENSE
IL
Enumeration date
07/30/2008
Last updated
06/17/2015
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