Provider Demographics
NPI:1134317571
Name:WAIMEA PACIFIC ENTERPRISES, LLC
Entity Type:Organization
Organization Name:WAIMEA PACIFIC ENTERPRISES, LLC
Other - Org Name:LYN LAM, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-885-7511
Mailing Address - Street 1:PO BOX 7109
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7109
Mailing Address - Country:US
Mailing Address - Phone:808-885-7511
Mailing Address - Fax:808-885-0933
Practice Address - Street 1:65-1267 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8406
Practice Address - Country:US
Practice Address - Phone:808-885-7511
Practice Address - Fax:808-885-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH52723Medicare PIN