Provider Demographics
NPI:1477316727
Name:LAM, CHANDARONG SHAWN
Entity Type:Individual
Prefix:
First Name:CHANDARONG
Middle Name:SHAWN
Last Name:LAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 TURNING TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4161
Mailing Address - Country:US
Mailing Address - Phone:619-961-7461
Mailing Address - Fax:
Practice Address - Street 1:2420 TURNING TRAIL RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4161
Practice Address - Country:US
Practice Address - Phone:619-961-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028785363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care