Basic Information
| Provider Information | |||||||||
| NPI: | 1679589923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | KELVIN | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5096 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982275096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607382200 | ||||||||
| FaxNumber: | 3607525644 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 CORDATA PKWY | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982267123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607382200 | ||||||||
| FaxNumber: | 3607525644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 10/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 220329 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0012X | MD00048087 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207R00000X | MD00048087 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | MD00048087 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 6698 | AK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD1128W | 05 | AK | MEDICAID | 0230374 | 01 | WA | L&I AND CRIME VICTIMS | OTHER | 4439LA | 01 | WA | REGENCE | OTHER | 7379892 | 01 | WA | AETNA | OTHER | 1679589923 | 05 | WA | MEDICAID | 8482556 | 05 | WA | MEDICAID |