Healthcare Provider Details

I. General information

NPI: 1336060920
Provider Name (Legal Business Name): AMOR FATI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18032 HARTLUND LN
HUNTINGTON BEACH CA
92646-1510
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KHOI LAM
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 714-725-0608