Healthcare Provider Details

I. General information

NPI: 1386866077
Provider Name (Legal Business Name): LOAN KIM LAM D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LOAN KIM LAM DPM

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15303 AMBERLY DR STE C
TAMPA FL
33647-2308
US

IV. Provider business mailing address

15303 AMBERLY DR STE C
TAMPA FL
33647-2308
US

V. Phone/Fax

Practice location:
  • Phone: 813-212-6517
  • Fax: 813-212-6518
Mailing address:
  • Phone: 813-212-6517
  • Fax: 813-212-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberPO3302
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberPO3302
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: