Healthcare Provider Details

I. General information

NPI: 1902132244
Provider Name (Legal Business Name): DAVID KING LAM MD, DDS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 FIFTH STREET DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY
SAN FRANCISCO CA
94103-1208
US

IV. Provider business mailing address

155 FIFTH STREET DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY
SAN FRANCISCO CA
94103-1208
US

V. Phone/Fax

Practice location:
  • Phone: 631-416-0363
  • Fax:
Mailing address:
  • Phone: 631-416-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number059354
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number107193
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number059354
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number107193
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number059354
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number107193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: