Healthcare Provider Details

I. General information

NPI: 1427789932
Provider Name (Legal Business Name): JENNY LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 ROSECRANS AVE STE 300
MANHATTAN BEACH CA
90266-2494
US

IV. Provider business mailing address

1230 ROSECRANS AVE STE 300
MANHATTAN BEACH CA
90266-2494
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-8402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161799
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: