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General NPI Number Information
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NPI Number | 1295841294
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Entity Type | Organization
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Legal Business Name | JIM W LAM MD PROF CORP
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 27068 LA PAZ RD #454
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3041
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Country | US
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Telephone | 949-581-2505
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Fax | 949-581-3135
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Provider Business Mailing Address
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Address Line | 27068 LA PAZ RD #454
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3041
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Country | US
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Telephone | 949-581-2505
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Fax | 949-581-3135
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIM W LAM
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Credential | M.D.
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Telephone | 949-581-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G51171
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License Number State | CA
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