Provider Demographics
NPI:1104975655
Name:KAM, JEANELLE LEILANI (MD)
Entity type:Individual
Prefix:
First Name:JEANELLE
Middle Name:LEILANI
Last Name:KAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 200 E
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6913
Mailing Address - Country:US
Mailing Address - Phone:808-233-9682
Mailing Address - Fax:
Practice Address - Street 1:1341 W MOCKINGBIRD LN
Practice Address - Street 2:SUITE 200 E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6913
Practice Address - Country:US
Practice Address - Phone:214-647-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95484207V00000X
TXP7790208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology