Provider Demographics
NPI:1063570992
Name:TAM, JENNIFER NGAI YEN (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NGAI YEN
Last Name:TAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:7862 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6712
Mailing Address - Country:US
Mailing Address - Phone:619-644-6405
Mailing Address - Fax:619-644-6495
Practice Address - Street 1:7862 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6712
Practice Address - Country:US
Practice Address - Phone:619-644-6405
Practice Address - Fax:619-461-5158
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12707T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12707AMedicare PIN