MEDICARE: JENNIFER LAM DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95019418	CA
2	163W00000X	Registered Nurse	95233635	CA

General Provider Information

NPI Number	:	1134888530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAM DNP

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 S ARROYO PKWY STE 330
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3264
Country	:	US
Telephone Number	:	626-585-4120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	02/18/2026

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