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General NPI Number Information
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NPI Number | 1467453399
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Entity Type | Individual
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Provider Name | PHUONG BICH LAM DDS
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Gender | Female
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 15000 CRENSHAW BLVD SUITE 104A
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City | GARDENA
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State | CA
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Zip | 90249-3647
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Country | US
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Telephone | 310-323-2629
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Fax | 310-323-2631
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Provider Business Mailing Address
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Address Line | 16047 CRESTLINE DR
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City | LA MIRADA
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State | CA
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Zip | 90638-3457
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Country | US
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Telephone | 562-947-4753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 49921
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License Number State | CA
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