1467453399 NPI number — PHUONG BICH LAM DDS

Table of content: PHUONG BICH LAM DDS (NPI 1467453399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467453399 NPI number — PHUONG BICH LAM DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAM
Provider First Name:
PHUONG
Provider Middle Name:
BICH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467453399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16047 CRESTLINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MIRADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90638-3457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-947-4753
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15000 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 104A
Provider Business Practice Location Address City Name:
GARDENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90249-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-323-2629
Provider Business Practice Location Address Fax Number:
310-323-2631
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  49921 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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