Healthcare Provider Details

I. General information

NPI: 1215819826
Provider Name (Legal Business Name): KHOI LAM PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MINH LAM

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N EUCLID ST STE 208
ANAHEIM CA
92801-4132
US

IV. Provider business mailing address

PO BOX 1395
WESTMINSTER CA
92684-1395
US

V. Phone/Fax

Practice location:
  • Phone: 714-725-0608
  • Fax:
Mailing address:
  • Phone: 714-725-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: