Provider Demographics
NPI:1831560374
Name:CARLOS B.C. LAM, M.D.
Entity type:Organization
Organization Name:CARLOS B.C. LAM, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-455-9095
Mailing Address - Street 1:1481 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2601
Mailing Address - Country:US
Mailing Address - Phone:808-946-0225
Mailing Address - Fax:808-951-7222
Practice Address - Street 1:1481 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2601
Practice Address - Country:US
Practice Address - Phone:808-946-0225
Practice Address - Fax:808-951-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 4664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE72004Medicare PIN