Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1497248215 |
---|---|
Provider Name | Simon Lam |
First Address | Azusa, CA 91702-1920 |
Second Address | Azusa, CA 91702-1920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |