Active NPI
Avitality Medical Professional Corporation
- Family Medicine Physician
- Ontario, CA
National Provider Identifier
1457269136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- AVITALITY MEDICAL PROFESSIONAL CORPORATION
- Practice address
- 653 E E St Ste 109
Ontario, CA 91764-4257 - Phone
- (909) 395-9888
- NPI assigned
- Sep 1, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lan Lam, PAC
- Title
- Owner
- Phone
- (909) 395-9888
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
653 E E St Ste 109
Ontario, CA 91764-4257
Mailing address
653 E E St Ste 109
Ontario, CA 91764-4257
Phone (909) 395-9888
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788220800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1789257600000",
"number": "1457269136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "653 E E ST STE 109",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917644257",
"telephone_number": "909-395-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "653 E E ST STE 109",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917644257",
"telephone_number": "909-395-9888"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVITALITY MEDICAL PROFESSIONAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-01",
"last_updated": "2026-09-13",
"certification_date": "2026-09-13",
"status": "A",
"authorized_official_last_name": "LAM",
"authorized_official_first_name": "LAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "909-395-9888",
"authorized_official_credential": "PAC"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.