Active NPI
Stacey Lam, DDS
- Pediatric Dentistry
- East Palo Alto, CA
National Provider Identifier
1194953679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 56054
- Practice address
- 1798 Bay Rd Ste a
East Palo Alto, CA 94303-5312 - Phone
- (650) 289-7700
- NPI assigned
- Jun 23, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 56054 | CA | Primary |
Addresses
Primary practice location
1798 Bay Rd Ste a
East Palo Alto, CA 94303-5312
Mailing address
1798 Bay Rd Ste a
East Palo Alto, CA 94303-5312
Other names 1
- Dr. Stacey Lum
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 |
|---|---|---|---|
| 56054 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355356800000",
"number": "1194953679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1798 BAY RD STE A",
"city": "EAST PALO ALTO",
"state": "CA",
"postal_code": "943035312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1798 BAY RD STE A",
"city": "EAST PALO ALTO",
"state": "CA",
"postal_code": "943035312",
"telephone_number": "650-289-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAM",
"first_name": "STACEY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-23",
"last_updated": "2012-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "56054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STACEY",
"last_name": "LUM",
"prefix": "DR.",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in East Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.