Provider Demographics
NPI:1033301940
Name:LUM, CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:LUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6057 N 1ST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5468
Mailing Address - Country:US
Mailing Address - Phone:559-446-1065
Mailing Address - Fax:559-436-8193
Practice Address - Street 1:6057 N 1ST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5468
Practice Address - Country:US
Practice Address - Phone:559-446-1065
Practice Address - Fax:559-436-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery