Active NPI
Michael Gary Lum, DDS
- Prosthodontics
- San Diego, CA
National Provider Identifier
1619103546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 53922
- Practice address
- 12264 El Camino Real
Suite 306
San Diego, CA 92130-3058 - Phone
- (858) 755-9810
- NPI assigned
- Jun 5, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 53922 | CA | Primary |
Addresses
Primary practice location
12264 El Camino Real
Suite 306
San Diego, CA 92130-3058
Mailing address
12264 El Camino Real
Suite 306
San Diego, CA 92130-3058
Phone (858) 755-9810
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 |
|---|---|---|---|
| 53922 | CA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Miguel Grillo, DMD | Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Prosthodontics
- San Diego, CA
- NPI 1831414200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244160000000",
"number": "1619103546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12264 EL CAMINO REAL",
"address_2": "SUITE 306",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921303058",
"telephone_number": "858-755-9810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12264 EL CAMINO REAL",
"address_2": "SUITE 306",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921303058",
"telephone_number": "858-755-9810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "MICHAEL",
"middle_name": "GARY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-05",
"last_updated": "2009-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "53922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.