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General NPI Number Information
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NPI Number | 1629560727
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Entity Type | Individual
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Provider Name | JESSICA MICHELLE LAM DMD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 13450 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-5806
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Country | US
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Telephone | 310-377-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 501 W OLYMPIC BLVD APT 705
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City | LOS ANGELES
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State | CA
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Zip | 90015-1450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102474
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License Number State | CA
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