Provider Demographics
NPI:1891035341
Name:LAM, VINH (BCBA)
Entity Type:Individual
Prefix:
First Name:VINH
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 E LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4590
Mailing Address - Country:US
Mailing Address - Phone:714-732-7348
Mailing Address - Fax:
Practice Address - Street 1:7634 E LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-4590
Practice Address - Country:US
Practice Address - Phone:714-732-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11700103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-12-11700OtherBCBA CERTIFICATE NUMBER