Individual
JASON KHOA LAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1402 S GRAND BLVD RM 157, SAINT LOUIS, MO 63104-1004
(314) 977-8887
Mailing address
1402 S GRAND BLVD RM 157, SAINT LOUIS, MO 63104-1004
(314) 977-8887
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101020471
MI
208000000X
Pediatrics Physician
5101020471
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2017011857
MO
390200000X
Student in an Organized Health Care Education/Training Program
5101020471
MI
Other
Enumeration date
05/09/2013
Last updated
12/06/2021
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