Healthcare Provider Details

I. General information

NPI: 1376571216
Provider Name (Legal Business Name): PETER LAM THOAI PHUC, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 E HOLT AVE
POMONA CA
91767-5833
US

IV. Provider business mailing address

2728 E 1ST ST
LONG BEACH CA
90803-2512
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-1946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT10558
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA88219
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28250
License Number StateCA

VIII. Authorized Official

Name: DR. PETER (PHUC) THOAI LAM
Title or Position: CEO
Credential: M.D.
Phone: 714-209-8319