Provider Demographics
NPI:1134232465
Name:LAM, VIRGINIA HM (PA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:HM
Last Name:LAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 ULUNAHELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4338
Mailing Address - Country:US
Mailing Address - Phone:808-263-0436
Mailing Address - Fax:
Practice Address - Street 1:1242 ULUNAHELE ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4338
Practice Address - Country:US
Practice Address - Phone:808-263-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-9363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant