Provider Demographics
NPI:1376617787
Name:LAM, TAYLOR VUONG (OD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:VUONG
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 GARVEY AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2087
Mailing Address - Country:US
Mailing Address - Phone:626-401-0324
Mailing Address - Fax:626-401-9224
Practice Address - Street 1:10012 GARVEY AVE STE 12
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2087
Practice Address - Country:US
Practice Address - Phone:626-401-0324
Practice Address - Fax:626-401-9224
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11907T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO119070Medicaid
CASD0119070OtherBLUE SHIELD OF CALIFORNIA
CA3391835OtherAETNA
U92692Medicare UPIN
CASDO119070Medicaid