Provider Demographics
NPI:1083986723
Name:LAM, JESSICA (PA-C, MSHS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:PA-C, MSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160D PITTSFORD VICTOR RD BLDG D2
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3818
Mailing Address - Country:US
Mailing Address - Phone:585-218-8006
Mailing Address - Fax:585-218-8099
Practice Address - Street 1:230 S MAIN ST STE B-100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-571-5900
Practice Address - Fax:714-541-0450
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21955363AM0700X
CA21955363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21955OtherMEDICAL LICENSE