Healthcare Provider Details

I. General information

NPI: 1063916724
Provider Name (Legal Business Name): MR. LAP KIM NAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 S WHITE RD STE 200
SAN JOSE CA
95148-2073
US

IV. Provider business mailing address

2670 S WHITE RD STE 200
SAN JOSE CA
95148-2073
US

V. Phone/Fax

Practice location:
  • Phone: 408-937-1553
  • Fax: 408-516-0053
Mailing address:
  • Phone: 408-937-1553
  • Fax: 408-516-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: