Provider Demographics
NPI:1134322373
Name:LAM, KEVIN KWAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KWAN
Last Name:LAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GOODLETTE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5617
Mailing Address - Country:US
Mailing Address - Phone:239-430-3668
Mailing Address - Fax:866-798-6785
Practice Address - Street 1:730 GOODLETTE RD STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5617
Practice Address - Country:US
Practice Address - Phone:239-430-3668
Practice Address - Fax:866-798-6785
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3169213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65898OtherBCBS FLORIDA
FL65898ZOtherMEDICARE
FL65898ZOtherMEDICARE
FL5523550001Medicare NSC
V06356Medicare UPIN