Healthcare Provider Details

I. General information

NPI: 1639411473
Provider Name (Legal Business Name): GIANG LAM A PROFESSION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 S FORT APACHE RD 110
LAS VEGAS NV
89148-6752
US

IV. Provider business mailing address

6545 S FORT APACHE RD 110
LAS VEGAS NV
89148-6752
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-4444
  • Fax: 702-749-6200
Mailing address:
  • Phone: 702-331-4444
  • Fax: 702-749-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number5141
License Number StateNV

VIII. Authorized Official

Name: DR. GIANG CHI LAM
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 702-331-4444