Active NPI
Lam Chittaphong, DDS
- Endodontics
- San Diego, CA
National Provider Identifier
1003012402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 53983
- Practice address
- 9888 Carroll Centre Rd
Suite #120
San Diego, CA 92126-4579 - Phone
- (858) 722-6332
- Fax
- (888) 514-1239
- NPI assigned
- Jun 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 53983 | CA | Primary |
Addresses
Primary practice location
9888 Carroll Centre Rd
Suite #120
San Diego, CA 92126-4579
Mailing address
9888 Carroll Centre Rd
Suite #120
San Diego, CA 92126-4579
Phone (858) 722-6332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53983 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412121600000",
"number": "1003012402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9888 CARROLL CENTRE RD",
"address_2": "SUITE #120",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264579",
"telephone_number": "858-722-6332",
"fax_number": "888-514-1239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9888 CARROLL CENTRE RD",
"address_2": "SUITE #120",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264579",
"telephone_number": "858-722-6332",
"fax_number": "888-514-1239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHITTAPHONG",
"first_name": "LAM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-22",
"last_updated": "2014-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "53983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.