Healthcare Provider Details

I. General information

NPI: 1770242190
Provider Name (Legal Business Name): HIEN LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

IV. Provider business mailing address

125 SHOREWAY RD STE A
SAN CARLOS CA
94070-2718
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax:
Mailing address:
  • Phone: 650-556-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: