Provider Demographics
NPI:1417219171
Name:LAM, DUNG CHRISTOPHER (RDH)
Entity Type:Individual
Prefix:MR
First Name:DUNG
Middle Name:CHRISTOPHER
Last Name:LAM
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 NATIONAL BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4062
Mailing Address - Country:US
Mailing Address - Phone:626-641-8558
Mailing Address - Fax:
Practice Address - Street 1:11015 NATIONAL BLVD APT 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4062
Practice Address - Country:US
Practice Address - Phone:626-641-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 26414124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist