MEDICARE: JONATHAN KENDRICK LAM PA-C

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	363A00000X	Physician Assistant	PA60964048	WA
2	363AM0700X	Medical Physician Assistant	PA60964048	WA

General Provider Information

NPI Number	:	1720540867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KENDRICK LAM PA-C

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-1105
Country	:	US
Telephone Number	:	206-520-5000
Fax Number	:

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

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	10/29/2024

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