MEDICARE: PHUONG BICH LAM DDS

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	122300000X	Dentist	49921	CA

General Provider Information

NPI Number	:	1467453399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG BICH LAM DDS

Provider Business Mailing Address
First Line	:	16047 CRESTLINE DR
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-3457
Country	:	US
Telephone Number	:	562-947-4753
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 CRENSHAW BLVD
Second Line	:	SUITE 104A
City	:	GARDENA
State	:	CA
Zip	:	90249-3647
Country	:	US
Telephone Number	:	310-323-2629
Fax Number	:	310-323-2631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/16/2016

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Directions to “ PHUONG BICH LAM DDS” Practice Location

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