Healthcare Provider Details

I. General information

NPI: 1992231682
Provider Name (Legal Business Name): LAM PHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N HARBOR BLVD STE 101
FULLERTON CA
92835-4107
US

IV. Provider business mailing address

75 ENTERPRISE STE 200
ALISO VIEJO CA
92656-2626
US

V. Phone/Fax

Practice location:
  • Phone: 714-888-2080
  • Fax:
Mailing address:
  • Phone: 949-688-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA171632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: