Individual provider Active NPI

Wan CHI Lam, D.D.S

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1174675730
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
048097 Issued in NY
Practice address
824 55TH St FL 1
Brooklyn, NY 11220-3213
Phone
(718) 438-0734
Fax
(718) 438-0736
NPI assigned
Jan 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 048097 NY Primary

Addresses

Primary practice location

824 55TH St FL 1
Brooklyn, NY 11220-3213

Mailing address

116 Winchester Ave
Staten Island, NY 10312-6232
Phone (718) 438-0734

Other identifiers 1

IdentifierTypeStateIssuer
02190843MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160608000750 NY Order and Referring Only - DentistPractitioner - Dentist 8022308758

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174675730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 WINCHESTER AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103126232",
            "telephone_number": "718-438-0734",
            "fax_number": "718-438-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 55TH ST FL 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203213",
            "telephone_number": "718-438-0734",
            "fax_number": "718-438-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "WAN",
        "middle_name": "CHI",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "048097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02190843",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.