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General NPI Number Information
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NPI Number | 1184277063
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Entity Type | Organization
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Legal Business Name | LAM MD
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2492 WALNUT AVE STE 100
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City | TUSTIN
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State | CA
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Zip | 92780-6953
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Country | US
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Telephone | 714-709-8000
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Fax | 714-709-8080
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Provider Business Mailing Address
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Address Line | 2492 WALNUT AVE STE 100
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City | TUSTIN
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State | CA
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Zip | 92780-6953
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Country | US
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Telephone | 714-709-8000
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Fax | 714-709-8080
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARRIE JASMINE LAM
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Credential | MD
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Telephone | 626-993-4034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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