MEDICARE: PAUL K. LAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376G00000X	Nursing Home Administrator	079200739	CA

General Provider Information

NPI Number	:	1508742362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL K. LAM

Provider Business Mailing Address
First Line	:	2181 WAYNE DR
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2359
Country	:	US
Telephone Number	:	510-759-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2181 WAYNE DR
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2359
Country	:	US
Telephone Number	:	510-759-8889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2025
Last Update Date	:	08/15/2025

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