Provider Demographics
NPI:1508287491
Name:LAM, NGUYEN (RDN)
Entity Type:Individual
Prefix:MR
First Name:NGUYEN
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KOSCIUSZKO ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4909
Mailing Address - Country:US
Mailing Address - Phone:337-277-0904
Mailing Address - Fax:
Practice Address - Street 1:18 KOSCIUSZKO ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4909
Practice Address - Country:US
Practice Address - Phone:337-277-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1020563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered