Healthcare Provider Details

I. General information

NPI: 1720961956
Provider Name (Legal Business Name): JENNIFER DIEM LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S BROADWAY
WALNUT CREEK CA
94596-5208
US

IV. Provider business mailing address

129 PEONY CT
FREMONT CA
94538-2425
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-3440
  • Fax:
Mailing address:
  • Phone: 510-378-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: