Provider Demographics
NPI:1396045613
Name:LAM, CUONG HUY (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:HUY
Last Name:LAM
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MBA
Mailing Address - Street 1:1715 CAMDEN AVE
Mailing Address - Street 2:APT # 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4473
Mailing Address - Country:US
Mailing Address - Phone:714-931-9548
Mailing Address - Fax:
Practice Address - Street 1:4867 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:323-824-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1107312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology