Provider Demographics
NPI:1700969920
Name:LAM, WAI-KUEN (MD)
Entity Type:Individual
Prefix:
First Name:WAI-KUEN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 MAPLE AVE STE 2L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3868
Mailing Address - Country:US
Mailing Address - Phone:718-888-9202
Mailing Address - Fax:718-888-9204
Practice Address - Street 1:13630 MAPLE AVE STE 2L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3868
Practice Address - Country:US
Practice Address - Phone:718-888-9202
Practice Address - Fax:718-888-9204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01563813Medicaid
NY01563813Medicaid
NYG01652Medicare UPIN