Healthcare Provider Details

I. General information

NPI: 1518977735
Provider Name (Legal Business Name): BINH CAM LIEU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 MISSION AVE
OCEANSIDE CA
92057-6541
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-901-5010
  • Fax: 760-433-1263
Mailing address:
  • Phone: 760-901-5010
  • Fax: 760-433-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA75402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: