Provider Demographics
NPI:1689294878
Name:LAM, LILY (RD, MS)
Entity type:Individual
Prefix:MISS
First Name:LILY
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S ST ANDREWS PL APT 217
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4360
Mailing Address - Country:US
Mailing Address - Phone:909-569-7312
Mailing Address - Fax:
Practice Address - Street 1:4640 ADMIRALTY WAY # 901
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-577-5540
Practice Address - Fax:310-577-5616
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86112541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered