Wilson Tam

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

103358 Issued in CA

Practice address

110 Town Center Pkwy Ste a
Santee, CA 92071-5801

Phone

(619) 396-2477

NPI assigned

Jun 30, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• C Pham & S Mauseth Dental Corporation

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Chula Vista, CA
  • NPI 1548051287
  NPD (past)
• Healthy Smiles Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Brooklyn, NY
  • NPI 1144889924
  NPD (past)

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

{
    "created_epoch": "1530316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1467947572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7995 CIVITA BLVD APT 312",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921085212",
            "telephone_number": "415-472-9834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 TOWN CENTER PKWY STE A",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920715801",
            "telephone_number": "619-396-2477"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 Birch Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Chula Vista",
            "state": "CA",
            "postal_code": "919152003",
            "country_code": "US",
            "telephone_number": "619-391-9287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAM",
        "first_name": "WILSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-30",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "061312",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "103358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audrey Sun
• Theresa Anne Swank, MD
• Sweetbriar Marriage and Family Therapy Corporation
• Debie Ai Taguchi, L.AC.
• Diana Taiz, DMD
• Emmanuel Gonzales Tanay
• Carla Abigail Rumbaoa Tayag, LVN, RN
• Michelle Ganangan Tello
• Nicholas Adam Thacker, D.D.S.
• The Learning Choice Academy

• Pediatric Dentistry in Santee, CA
• Providers in Santee, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.