Provider Demographics
NPI:1326232497
Name:LAM, KA MING
Entity Type:Individual
Prefix:MR
First Name:KA MING
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DERRICK
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1290 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2304
Mailing Address - Country:US
Mailing Address - Phone:650-583-1260
Mailing Address - Fax:
Practice Address - Street 1:1290 COMMODORE DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2304
Practice Address - Country:US
Practice Address - Phone:650-583-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA52609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist