Healthcare Provider Details

I. General information

NPI: 1316608748
Provider Name (Legal Business Name): ANDREW LAM CAO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 MARTIN LUTHER KING JR WAY
BERKELEY CA
94704-3238
US

IV. Provider business mailing address

3939 MONROE AVE APT 217
FREMONT CA
94536-6951
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-5290
  • Fax:
Mailing address:
  • Phone: 415-307-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95253275
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95253275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: