Basic Information
| Provider Information | |||||||||
| NPI: | 1922546084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | HONG | ||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 W ORANGEWOOD AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928685056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146962862 | ||||||||
| FaxNumber: | 7142429308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 W ORANGEWOOD AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928685056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146962862 | ||||||||
| FaxNumber: | 7142429308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2017 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-19-35884 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.