Healthcare Provider Details

I. General information

NPI: 1164187761
Provider Name (Legal Business Name): MR. CHUNG MAN ALEX LAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 8TH ST STE 210
OAKLAND CA
94607-6527
US

IV. Provider business mailing address

310 8TH ST STE 201
OAKLAND CA
94607-6527
US

V. Phone/Fax

Practice location:
  • Phone: 510-735-3900
  • Fax: 510-735-3941
Mailing address:
  • Phone: 510-917-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153772
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: