Provider Demographics
NPI:1558491647
Name:LAM, GHIM MUN (LIC ACU)
Entity Type:Individual
Prefix:
First Name:GHIM
Middle Name:MUN
Last Name:LAM
Suffix:
Gender:M
Credentials:LIC ACU
Other - Prefix:
Other - First Name:GHIM
Other - Middle Name:M
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:336 N CENTRAL AVE
Mailing Address - Street 2:# 1
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3123
Mailing Address - Country:US
Mailing Address - Phone:818-500-1425
Mailing Address - Fax:
Practice Address - Street 1:336 N CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3125
Practice Address - Country:US
Practice Address - Phone:818-500-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist