Provider Demographics
NPI:1649594979
Name:LAM, KHANH MINH (OMD, LAC)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:MINH
Last Name:LAM
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 LINCOLN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4615
Mailing Address - Country:US
Mailing Address - Phone:714-952-1080
Mailing Address - Fax:714-952-1660
Practice Address - Street 1:7151 LINCOLN AVE STE K
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4615
Practice Address - Country:US
Practice Address - Phone:714-952-1080
Practice Address - Fax:714-952-1660
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37990Medicare PIN