1083386114 NPI number — JIM LAM DDS PLLC

Table of content: (NPI 1083386114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083386114 NPI number — JIM LAM DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIM LAM DDS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083386114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6821 DONIPHAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANUTILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79835-5402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-877-4949
Provider Business Mailing Address Fax Number:
915-877-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6821 DONIPHAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANUTILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79835-5402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-877-4949
Provider Business Practice Location Address Fax Number:
915-877-4242
Provider Enumeration Date:
09/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
626-235-6572

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36284785 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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