Provider Demographics
NPI:1225741382
Name:TAM, LONG YIN (PA)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:YIN
Last Name:TAM
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 E ORANGEWOOD AVE # UNITE429
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6540
Mailing Address - Country:US
Mailing Address - Phone:510-612-8813
Mailing Address - Fax:
Practice Address - Street 1:3401 AERO JET AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2801
Practice Address - Country:US
Practice Address - Phone:626-286-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant