Provider Demographics
NPI:1386086320
Name:LAM, KALILINE KHY (OD)
Entity type:Individual
Prefix:
First Name:KALILINE
Middle Name:KHY
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 AUTO CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6700
Mailing Address - Country:US
Mailing Address - Phone:909-305-4892
Mailing Address - Fax:626-779-7042
Practice Address - Street 1:1950 AUTO CENTRE DR
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6700
Practice Address - Country:US
Practice Address - Phone:909-305-4892
Practice Address - Fax:626-779-7042
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14735 TLG152W00000X
NV769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist