Provider Demographics
NPI:1952764185
Name:LAM, KIM TUYEN BUI (DO)
Entity Type:Individual
Prefix:MS
First Name:KIM TUYEN
Middle Name:BUI
Last Name:LAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIM TUYEN
Other - Middle Name:BUI
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:12 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1125
Mailing Address - Country:US
Mailing Address - Phone:917-412-4965
Mailing Address - Fax:
Practice Address - Street 1:12 CORNELL DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1125
Practice Address - Country:US
Practice Address - Phone:917-412-4965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304637207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology