Provider Demographics
NPI:1467453399
Name:LAM, PHUONG BICH (DDS)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:BICH
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16047 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3457
Mailing Address - Country:US
Mailing Address - Phone:562-947-4753
Mailing Address - Fax:
Practice Address - Street 1:15000 CRENSHAW BLVD
Practice Address - Street 2:SUITE 104A
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3647
Practice Address - Country:US
Practice Address - Phone:310-323-2629
Practice Address - Fax:310-323-2631
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist