Healthcare Provider Details

I. General information

NPI: 1952926073
Provider Name (Legal Business Name): VIVIAN WANGMEI LAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR STE 400
FAIRFAX VA
22033-1715
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR STE 400
FAIRFAX VA
22033-1715
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-2020
  • Fax:
Mailing address:
  • Phone: 703-391-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD482818
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: