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General NPI Number Information
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NPI Number | 1255697736
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Entity Type | Organization
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Legal Business Name | GOLDEN EAGLE MEDICAL NETWORK
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 1025 N WILLOW AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-1617
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Country | US
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Telephone | 626-960-6666
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Fax | 626-960-5666
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Provider Business Mailing Address
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Address Line | 1025 N WILLOW AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-1617
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Country | US
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Telephone | 626-960-6666
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Fax | 626-960-5666
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACINTO LAM
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Credential | MD
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Telephone | 626-960-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A 39722
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License Number State | CA
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