Healthcare Provider Details

I. General information

NPI: 1023577848
Provider Name (Legal Business Name): KHANG C LAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY ST
EVANSVILLE IN
47710-1658
US

IV. Provider business mailing address

1100 N PALM CANYON DR STE 109
PALM SPRINGS CA
92262-4418
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-5000
  • Fax:
Mailing address:
  • Phone: 909-558-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number02006886A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02006886B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: