MEDICARE: JESSICA LAM DDS

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	1223G0001X	General Practice Dentistry	104086	CA

General Provider Information

NPI Number	:	1497309488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAM DDS

Provider Business Mailing Address
First Line	:	2539 29TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2929
Country	:	US
Telephone Number	:	415-816-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 GEARY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1910
Country	:	US
Telephone Number	:	415-386-0790
Fax Number	:

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

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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