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General NPI Number Information
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NPI Number | 1952668220
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Entity Type | Individual
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Provider Name | COREY JONATHAN LUM D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 10040 ALTA DR STE 350
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City | LAS VEGAS
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State | NV
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Zip | 89145-8658
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Country | US
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Telephone | 702-360-7600
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Fax | 702-363-3814
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Provider Business Mailing Address
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Address Line | 6355 S BUFFALO DR FL 3
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City | LAS VEGAS
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State | NV
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Zip | 89113-2133
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Country | US
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Telephone | 702-216-3346
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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 | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | DOS-1665
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | DO3065
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DOS-1665
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License Number State | HI
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DO3065
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License Number State | NV
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