Active NPI
Phuong Bich Lam, DDS
- Dentist
- Gardena, CA
National Provider Identifier
1467453399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 49921
- Practice address
- 15000 Crenshaw Blvd
Suite 104a
Gardena, CA 90249-3647 - Phone
- (310) 323-2629
- Fax
- (310) 323-2631
- NPI assigned
- Aug 2, 2005
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 49921 | CA | Primary |
Addresses
Primary practice location
15000 Crenshaw Blvd
Suite 104a
Gardena, CA 90249-3647
Mailing address
16047 Crestline Dr
La Mirada, CA 90638-3457
Phone (562) 947-4753
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 |
|---|---|---|---|
| 49921 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473984000000",
"number": "1467453399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16047 CRESTLINE DR",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906383457",
"telephone_number": "562-947-4753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15000 CRENSHAW BLVD",
"address_2": "SUITE 104A",
"city": "GARDENA",
"state": "CA",
"postal_code": "902493647",
"telephone_number": "310-323-2629",
"fax_number": "310-323-2631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAM",
"first_name": "PHUONG",
"middle_name": "BICH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-02",
"last_updated": "2016-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "49921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.