Provider Demographics
NPI:1386866077
Name:LAM, LOAN KIM (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOAN
Middle Name:KIM
Last Name:LAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:LOAN
Other - Middle Name:KIM
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456
Mailing Address - Country:US
Mailing Address - Phone:813-591-4570
Mailing Address - Fax:813-441-6116
Practice Address - Street 1:17501 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4521
Practice Address - Country:US
Practice Address - Phone:813-284-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3302213ES0103X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6397730001Medicare NSC