Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD11212 | HI |
NPI | 1114033040 |
---|---|
Provider Name | Dr. Jason Tai Pang Lam |
First Address | Wahiawa, HI 96786-1841 |
Second Address | Wahiawa, HI 96786-1841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |