Provider Demographics
NPI:1710164876
Name:LAM, KENNETH S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:LAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:818-952-0310
Mailing Address - Fax:818-952-1809
Practice Address - Street 1:1809 VERDUGO BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208
Practice Address - Country:US
Practice Address - Phone:818-952-0310
Practice Address - Fax:818-952-1809
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice