Active NPI
Jeremiah Lam
- General Practice Dentistry
- McHenry, IL
National Provider Identifier
1407695802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.035099
- Practice address
- 2964 Commerce Dr
McHenry, IL 60051-5409 - Phone
- (815) 363-0103
- NPI assigned
- May 23, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.035099 | IL | Primary |
Addresses
Primary practice location
2964 Commerce Dr
McHenry, IL 60051-5409
Mailing address
1105 Andover Dr
Mundelein, IL 60060-5503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.035099 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720656000000",
"number": "1407695802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 ANDOVER DR",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600605503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2964 COMMERCE DR",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600515409",
"telephone_number": "815-363-0103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAM",
"first_name": "JEREMIAH",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-23",
"last_updated": "2024-07-11",
"certification_date": "2024-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.035099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.