Provider Demographics
NPI:1497883136
Name:LAM, SAMSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2262
Mailing Address - Country:US
Mailing Address - Phone:646-262-3838
Mailing Address - Fax:
Practice Address - Street 1:8740 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-4000
Practice Address - Country:US
Practice Address - Phone:310-410-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505161223G0001X
CA567321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice