1659333649 NPI number — DICKSON LAM M.D.

Table of content: DICKSON LAM M.D. (NPI 1659333649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659333649 NPI number — DICKSON LAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAM
Provider First Name:
DICKSON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659333649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3905
Provider Second Line Business Mailing Address:
DEPT. 4204
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-3905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-514-9060
Provider Business Mailing Address Fax Number:
360-514-9041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 116TH AVE NE
Provider Second Line Business Practice Location Address:
HOSPITALISTS DEPT.
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-688-5072
Provider Business Practice Location Address Fax Number:
425-467-3310
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD00042658 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0173815 . This is a "L & I WORKERS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5341LA . This is a "REGENCE BLUESHIELD RIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8357352 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00122037 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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