MEDICARE: DR. LUM & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25939	CA

General Provider Information

NPI Number	:	1124272356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LUM & ASSOCIATES

Provider Business Mailing Address
First Line	:	21847 AVALON BLVD
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-3304
Country	:	US
Telephone Number	:	310-549-9710
Fax Number	:	310-549-4049

Provider Business Practice Location Address
First Line	:	21847 AVALON BLVD
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-3304
Country	:	US
Telephone Number	:	310-549-9710
Fax Number	:	310-549-4049

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDOLPH LUM
Credential	:	DDS
Telephone Number	:	310-549-0710

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	11/14/2008

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