Provider Demographics
NPI:1093229759
Name:JACINTO LAM MEDICAL GROUP
Entity Type:Organization
Organization Name:JACINTO LAM MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACINTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:323-562-3180
Mailing Address - Street 1:4811 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4316
Mailing Address - Country:US
Mailing Address - Phone:323-562-3180
Mailing Address - Fax:323-562-4979
Practice Address - Street 1:4811 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-4316
Practice Address - Country:US
Practice Address - Phone:323-562-3180
Practice Address - Fax:323-562-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty