Provider Demographics
NPI:1336119122
Name:LAM, VINH THUY (MD)
Entity Type:Individual
Prefix:
First Name:VINH
Middle Name:THUY
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3845
Mailing Address - Country:US
Mailing Address - Phone:714-361-4480
Mailing Address - Fax:714-361-4490
Practice Address - Street 1:396 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3845
Practice Address - Country:US
Practice Address - Phone:714-361-4480
Practice Address - Fax:714-361-4490
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG807252086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G807250Medicaid
CAH10471Medicare UPIN
CAW16029Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER