Healthcare Provider Details

I. General information

NPI: 1811307176
Provider Name (Legal Business Name): YAOHAN LAM DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 SW 107TH ST STE 100
OKLAHOMA CITY OK
73170-5244
US

IV. Provider business mailing address

926 SW 107TH ST STE 100
OKLAHOMA CITY OK
73170-5244
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-9788
  • Fax: 405-735-9882
Mailing address:
  • Phone: 405-735-9788
  • Fax: 405-735-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27838
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YAOHAN LAM
Title or Position: OWNER
Credential: M.D.
Phone: 405-361-8806