Provider Demographics
NPI:1285994244
Name:TIET, TAM (MD)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:
Last Name:TIET
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:707-308-2840
Mailing Address - Fax:707-573-5376
Practice Address - Street 1:1383 N MCDOWELL BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-308-2840
Practice Address - Fax:707-573-5376
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA132568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA132568OtherSTATE LICENSE
CAFT4898005OtherFEDERAL DEA LICENSE