Healthcare Provider Details

I. General information

NPI: 1518930197
Provider Name (Legal Business Name): PHUC THOAI LAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER THOAI LAM MD

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10872 WESTMINSTER AVE SUITE 114
GARDEN GROVE CA
92843-4981
US

IV. Provider business mailing address

467 ARCADIA WAY
SALINAS CA
93906-2178
US

V. Phone/Fax

Practice location:
  • Phone: 714-209-8319
  • Fax: 714-530-2365
Mailing address:
  • Phone: 714-209-8319
  • Fax: 831-444-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA 88219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: