Active NPI
Tam Tiet, MD
- Family Medicine Physician
- Petaluma, CA
National Provider Identifier
1285994244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A132568
- Practice address
- 1383 N McDowell Blvd Ste 150
Petaluma, CA 94954 - Phone
- (707) 308-2840
- Fax
- (707) 573-5376
- NPI assigned
- May 24, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A132568 | CA | Primary |
Addresses
Primary practice location
1383 N McDowell Blvd Ste 150
Petaluma, CA 94954
Mailing address
2350 W El Camino Real FL 2
Mountain View, CA 94040-6203
Phone (707) 308-2840
Other practice location 1
111 Raley Blvd
Suite 140
Chico, CA 95928-8351
Phone (530) 342-5776
Other practice location 2
3883 Airway Dr Ste 120
Santa Rosa, CA 95403-1678
Phone (707) 521-4495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A132568 | Other | CA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A132568 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1285994244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2350 W EL CAMINO REAL FL 2",
"city": "MOUNTAIN VIEW",
"state": "CA",
"postal_code": "940406203",
"telephone_number": "707-308-2840",
"fax_number": "707-573-5376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1383 N MCDOWELL BLVD STE 150",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "707-308-2840",
"fax_number": "707-573-5376"
}
],
"practiceLocations": [
{
"address_1": "111 Raley Blvd",
"address_2": "Suite 140",
"address_purpose": "LOCATION",
"city": "Chico",
"state": "CA",
"postal_code": "959288351",
"country_code": "US",
"telephone_number": "530-342-5776",
"fax_number": "530-898-0178",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3883 Airway Dr Ste 120",
"address_purpose": "LOCATION",
"city": "Santa Rosa",
"state": "CA",
"postal_code": "954031678",
"country_code": "US",
"telephone_number": "707-521-4495",
"fax_number": "707-573-5421",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TIET",
"first_name": "TAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-24",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A132568",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "A132568",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.