Healthcare Provider Details

I. General information

NPI: 1376477109
Provider Name (Legal Business Name): KANNIKA LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 POTRERO AVE
SUNNYVALE CA
94085-4116
US

IV. Provider business mailing address

157 LOTTIE LN
CAMPBELL CA
95008-3075
US

V. Phone/Fax

Practice location:
  • Phone: 888-926-9385
  • Fax: 408-716-2762
Mailing address:
  • Phone: 415-990-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number752673
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3667363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: