Individual provider Active NPI

Ian T Lam, DDS

  • Dentist
  • Sterling, VA
National Provider Identifier
1215412606
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401416251 Issued in VA
Practice address
23244 Meadowvale Glen CT
Sterling, VA 20166-2148
Phone
(703) 347-4678
NPI assigned
Oct 1, 2018
Last updated
Oct 1, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401416251 VA Primary

Addresses

Primary practice location

23244 Meadowvale Glen CT
Sterling, VA 20166-2148

Mailing address

23244 Meadowvale Glen CT
Sterling, VA 20166-2148
Phone (703) 347-4678

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20190207002816 VA Order and Referring Only - DentistPractitioner - Dentist 2264770783

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Interoperability endpoints

  • Direct secure messaging: ian.lam@gpwchc.eclinicaldirectplus.com

NPI Registry JSON

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1215412606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23244 MEADOWVALE GLEN CT",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201662148",
            "telephone_number": "703-347-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23244 MEADOWVALE GLEN CT",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201662148",
            "telephone_number": "703-347-4678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "IAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling, VA

Sources for this page

Verify at the official NPI Registry.