Provider Demographics
NPI:1104105030
Name:DAM, TANYA HOA (DO)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:HOA
Last Name:DAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 FLOYD AVE
Mailing Address - Street 2:D-116
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7923
Mailing Address - Country:US
Mailing Address - Phone:408-375-4998
Mailing Address - Fax:
Practice Address - Street 1:1541 FLORIDA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4429
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12410207RG0100X
TXP0569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology