Healthcare Provider Details

I. General information

NPI: 1821978131
Provider Name (Legal Business Name): ROBERT LAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N BRAND BLVD STE 600
GLENDALE CA
91203-2349
US

IV. Provider business mailing address

7221 HEIL AVE
HUNTINGTON BEACH CA
92647-4405
US

V. Phone/Fax

Practice location:
  • Phone: 818-476-4884
  • Fax:
Mailing address:
  • Phone: 323-702-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: