Healthcare Provider Details

I. General information

NPI: 1750348793
Provider Name (Legal Business Name): HARVEY LUM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 28038
APO AE
09112-8038
US

IV. Provider business mailing address

UNIT 28038
APO AE
09112-8038
US

V. Phone/Fax

Practice location:
  • Phone: 011499662834738
  • Fax:
Mailing address:
  • Phone: 011499662834738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32124
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: