Provider Demographics
NPI:1063669224
Name:LAM, WAI-HANG JACKIE (MD)
Entity Type:Individual
Prefix:
First Name:WAI-HANG
Middle Name:JACKIE
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1450 NORIEGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122
Mailing Address - Country:US
Mailing Address - Phone:415-391-9686
Mailing Address - Fax:415-352-5098
Practice Address - Street 1:1450 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122
Practice Address - Country:US
Practice Address - Phone:415-391-9686
Practice Address - Fax:415-352-5098
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine