Keith H Tam DDS Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

57293 Issued in CA

Legal business name

KEITH H TAM DDS INC

Doing business as

Lake Forest Pediatric Dentistry

Practice address

2674 San Miguel Dr
Newport Beach, CA 92660-5437

Phone

(949) 478-6628

NPI assigned

Nov 7, 2012

Last updated

Jan 27, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

KEITH TAM DDS PROFESSIONAL CORPAs reported in NPPES

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

Authorized official

Name

Dr. Keith H Tam, DDSNPI 1710141783

Title

Owner, DDS

Phone

(949) 322-9778

Specialties & licenses 1

Addresses

Other names 1

• Lake Forest Pediatric Dentistry Doing business as

Part of

Ktam DDS Dental Corp

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Keith Tam DDS Professional Corp

  dba Santa Maria Pediatric Dental Group

  • Dentist
  • Santa Maria, CA
  • NPI 1922541481
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keith H Tam, DDS

  • Pediatric Dentistry
  • Santa Maria, CA
  • NPI 1710141783
  NPD Authorized official

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1497009831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2674 SAN MIGUEL DR STE C",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605437",
            "telephone_number": "949-478-6628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2674 SAN MIGUEL DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605437",
            "telephone_number": "949-478-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH H TAM DDS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEITH TAM DDS PROFESSIONAL CORP",
        "enumeration_date": "2012-11-07",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "TAM",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER, DDS",
        "authorized_official_telephone_number": "949-322-9778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "57293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Forest Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Forest Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristie Anne Kee, ASW
• Nathalie Keeler
• Kyle Edward Keffer, MS, LMFT
• Sheri Denham Keffer, PH.D MFT
• Mitchell S Keil, PSYD
• Shahrooz Sean Kelishadi, MD
• Dylan Joseph Kelley
• Selah Kelley
• Timothy Kelley, MD
• Kelli a. Fox (Golden State Hospice)

• Pediatric Dentistry in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.