Healthcare Provider Details

I. General information

NPI: 1487865960
Provider Name (Legal Business Name): MRS. IRENE LAM FU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

IV. Provider business mailing address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

V. Phone/Fax

Practice location:
  • Phone: 510-924-7667
  • Fax: 510-878-7345
Mailing address:
  • Phone: 510-924-7667
  • Fax: 510-878-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: