Healthcare Provider Details

I. General information

NPI: 1205326451
Provider Name (Legal Business Name): JIMMY LAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 202
BEVERLY HILLS CA
90211-2285
US

IV. Provider business mailing address

221 LONGWOOD AVE
BOSTON MA
02115-5804
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3300
  • Fax:
Mailing address:
  • Phone: 617-732-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA191252
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number291933
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: