=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154535722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL LUM D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 01/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23639 HAWTHORNE BLVD SUITE 300
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-375-9595
-----------------------------------------------------
Fax | 310-375-2138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23639 HAWTHORNE BLVD SUITE 300
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-5930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-375-9595
-----------------------------------------------------
Fax | 310-375-2138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A8557
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------