Individual provider Active NPI

Lok Tam, LCSW

  • Clinical Social Worker
  • Covina, CA
National Provider Identifier
1063761963
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW90519 Issued in CA
Practice address
1126 N Grand Ave
Covina, CA 91724-1551
Phone
(626) 967-1667
Fax
(626) 967-6027
NPI assigned
Sep 6, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Case Manager/Care Coordinator 171M00000X
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Social Worker 1041C0700X LCSW90519 CA Primary

Addresses

Primary practice location

1126 N Grand Ave
Covina, CA 91724-1551

Mailing address

1126 N Grand Ave
Covina, CA 91724-1551
Phone (626) 967-1667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200728004057 CA Practitioner - Clinical Social Worker 8921423633 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW90519CAMDClinical Social Worker
90519CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Clinics Case Manager/Care Coordinator CurrentSince Mar 1, 2022 Accepting new patients
Pacific Clinics Case Manager/Care Coordinator CurrentSince Mar 1, 2022 Accepting new patients
Pacific Clinics Case Manager/Care Coordinator Current Accepting new patients

Locations

800 S Santa Anita Ave
Arcadia, CA 91006
Phone (626) 254-5043

251 Llewellyn Ave
Campbell, CA 95008
Phone (408) 364-4083

1020 S Arroyo Pkwy
Pasadena, CA 91105
Phone (626) 403-2794

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1063761963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241551",
            "telephone_number": "626-967-1667",
            "fax_number": "626-967-6027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241551",
            "telephone_number": "626-967-1667",
            "fax_number": "626-967-6027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAM",
        "first_name": "LOK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-06",
        "last_updated": "2022-01-14",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW90519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.