Provider Demographics
NPI:1023211612
Name:LAM, LAN KIM (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAN
Middle Name:KIM
Last Name:LAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 E E ST STE 109
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4257
Mailing Address - Country:US
Mailing Address - Phone:909-395-9888
Mailing Address - Fax:
Practice Address - Street 1:653 E E ST STE 109
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4257
Practice Address - Country:US
Practice Address - Phone:909-395-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant