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General NPI Number Information
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NPI Number | 1275012684
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Entity Type | Organization
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Legal Business Name | KATHY LAM DDS, LLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 311 S NAPERVILLE RD STE A
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City | WHEATON
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State | IL
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Zip | 60187-5473
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Country | US
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Telephone | 630-653-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 210 CHAPIN WAY
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City | OSWEGO
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State | IL
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Zip | 60543-5010
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Country | US
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Telephone | 630-346-0563
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHY LAM
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Credential | DDS
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Telephone | 630-653-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019026695
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License Number State | IL
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