Provider Demographics
NPI:1407814155
Name:LAM, HENRY MAN - HUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:MAN - HUNG
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 1:3313 M ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2714
Mailing Address - Country:US
Mailing Address - Phone:209-722-3924
Mailing Address - Fax:209-384-5761
Practice Address - Street 1:3313 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2714
Practice Address - Country:US
Practice Address - Phone:209-722-3924
Practice Address - Fax:209-384-5761
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC041629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C416290Medicaid
CA00C416290Medicaid
00C416290Medicare ID - Type Unspecified