Healthcare Provider Details

I. General information

NPI: 1265255236
Provider Name (Legal Business Name): MYLINE LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W OLIVE AVE
BURBANK CA
91506-2438
US

IV. Provider business mailing address

4643 LARRY AVE
BALDWIN PARK CA
91706-2573
US

V. Phone/Fax

Practice location:
  • Phone: 818-729-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: