Active NPI
Garrett Leong Lum, DMD
- Dentist
- Elk Grove, CA
National Provider Identifier
1295815447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 57499
- Practice address
- 9184 E Stockton Blvd
Elk Grove, CA 95624-9510 - Phone
- (916) 686-1101
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7004 | AZ | |
| Dentist | 122300000X | 57499 | CA | Primary |
Addresses
Primary practice location
9184 E Stockton Blvd
Elk Grove, CA 95624-9510
Mailing address
3650 Somerset Ave
Castro Valley, CA 94546-3439
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 |
|---|---|---|---|
| 57499 | CA | MD | Dentist |
Interoperability endpoints
- glum@direct.westerndental.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366675200000",
"number": "1295815447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3650 SOMERSET AVE",
"city": "CASTRO VALLEY",
"state": "CA",
"postal_code": "945463439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9184 E STOCKTON BLVD",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956249510",
"telephone_number": "916-686-1101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "GARRETT",
"middle_name": "LEONG",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2013-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "7004",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "57499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.