MEDICARE: WALTER LAM DDS, A PROFESSIONAL CORP.

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	261QD0000X	Dental Clinic/Center	41101	CA

General Provider Information

NPI Number	:	1700111713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER LAM DDS, A PROFESSIONAL CORP.

Provider Business Mailing Address
First Line	:	2707 E VALLEY BLVD STE 211
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3197
Country	:	US
Telephone Number	:	626-839-9977
Fax Number	:	626-768-7334

Provider Business Practice Location Address
First Line	:	2707 E VALLEY BLVD STE 211
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3197
Country	:	US
Telephone Number	:	626-839-9977
Fax Number	:	626-768-7334

Authorized Official
Title or Position	:	DENTIST
Name	:	WALTER LAM
Credential	:
Telephone Number	:	626-839-9977

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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