Provider Demographics
NPI:1497955306
Name:LAM, JESSE TZU TAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:TZU TAN
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-1461 KUHIO HWY.
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746
Mailing Address - Country:US
Mailing Address - Phone:808-220-7062
Mailing Address - Fax:
Practice Address - Street 1:4-1461 KUHIO HWY.
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:808-220-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics