Johnny Lum, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

000669 Issued in CT

Practice address

1389 W Main St
Waterbury, CT 06708-3104

Phone

(203) 755-5555

Fax

(203) 573-8523

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jon Lum Other name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: john.lum@xdr.hhchealthdirect.org
• Direct secure messaging: jlum318550@direct.ynhh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Diagnostic Pain Treatment Centers PC

  • Specialist
  • New Haven, CT
  • NPI 1881724912
  Medicare reassignment
• Waterbury Hospital

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1184615114
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1528016441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 UNION AVE APT 20",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068513735",
            "telephone_number": "203-919-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083104",
            "telephone_number": "203-755-5555",
            "fax_number": "203-573-8523"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Washington Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Hamden",
            "state": "CT",
            "postal_code": "065183267",
            "country_code": "US",
            "telephone_number": "321-341-0074",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Long Wharf Dr Ste 212",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065115593",
            "country_code": "US",
            "telephone_number": "203-624-4208",
            "fax_number": "203-624-4301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUM",
        "first_name": "JOHNNY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004085636",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JON",
            "last_name": "LUM",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Natalie Luciano, MSW INTERN
• Melinda Dasilva Lucke
• Jeffrey George Luddy, LCSW
• Awilda Altagracia Lugo Mendez, APRN
• Sky Anya Lukenberg, BSW
• Venetia Natasha Lush, B.S.
• Logan Stephen Lussier, RN
• Luxottica of America Inc.
• Bhupinder Singh Lyall, M.D.
• Audrey Lyles

• Medical Physician Assistant in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.