Provider Demographics
NPI:1851022735
Name:LAM, JEFFREY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PRESTON CT
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2514
Mailing Address - Country:US
Mailing Address - Phone:909-346-5332
Mailing Address - Fax:
Practice Address - Street 1:221 E HACIENDA AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6625
Practice Address - Country:US
Practice Address - Phone:408-376-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant