Provider Demographics
NPI:1154176097
Name:LAM, KIM VY (DDS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:VY
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24936 MOHR DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2376
Mailing Address - Country:US
Mailing Address - Phone:650-474-5000
Mailing Address - Fax:
Practice Address - Street 1:24936 MOHR DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2376
Practice Address - Country:US
Practice Address - Phone:650-474-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist