NPIMap

Organization Active NPI

Avitality Medical Professional Corporation

  • Family Medicine Physician
  • Ontario, CA
National Provider Identifier
1457269136
Registry record updated Sep 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
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
Last updated
Sep 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2026

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

Authorized official

Name
Lan Lam, PACNPI 1023211612
Title
Owner
Phone
(909) 395-9888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

National Provider Directory

National Provider Directory

Locations

653 E E St
Ste 109
Ontario, CA 91764
Phone (909) 395-9888

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.